Glaucoma Valve Surgery

Another surgical procedure for patients with glaucoma involves placement of a valve or tube device to help lower eye pressure. This procedure is usually reserved for patients with inflammatory or uveitic glaucoma or patients who have had prior filtration (trabeculectomy) surgery that failed. These devices are placed in the orbit against the outer wall of the eye called the sclera and sutured in place (the Ahmed valve is shown in the picture above). A tube runs forward from the device and is inserted into the front of the eye where it acts as a drain to shift fluid to the valve. This helps to lower the pressure inside the eye and prevent further damage to the optic nerve caused by glaucoma.

What to expect on surgery day:

You will arrive at the surgery center 30-60 minutes prior to your procedure. Once you have been checked-in and settled comfortably, you will be prepared for surgery. The area around your eyes will be cleaned and a sterile drape will be applied. You may be given a sedative to help you relax. Your eye will be numbed with topical or a local anesthesia. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking.

Using advanced microsurgical techniques and equipment, your doctor will create a tiny new channel between the inside of your eye and the outside of your eye. The drainage tube for the valve will be inserted into this opening to allow fluid to pass through to the valve positioned on the outside of the eye. The valve and tube are secured to the eye with small stitches and covered with the thin outer tissue of the eye, called the conjunctiva.

To keep the drainage tube protected, your doctor will apply an extremely small patch of donor sclera over the tube. Your eye pressure will be checked the next day after your procedure and drops may be prescribed to alleviate any soreness or swelling inside the eye. You should go home and relax for the rest of the day. Most patients resume normal activities within a few days.

Follow-up visits are necessary to monitor your eye pressure. It may take a few weeks to see the full pressure-lowering effect of this procedure, and adjustments may need to be made to the valve during this period. These adjustments may include:

Realistic expectations:

The success rate for this type of surgery is approximately 80 percent. However, everyone's eyes are unique and many people do require further treatments. This surgery is usually reserved for patients with more difficult cases where even filtration surgery doesn't prevent damage to the ocular nerve.

Serious complications with glaucoma valve surgery are extremely rare, but like any surgical procedure, it does have some risks. Going to a specialist experienced in glaucoma valve surgery can significantly minimize the risks.

If you and your doctor decide that glaucoma valve surgery is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

Procedures

What to expect on surgery day:

Realistic expectations: