Mechanism The device works by bypassing the trabecular meshwork and redirecting the outflow of aqueous humor through a small tube into an outlet chamber or bleb. The IOP generally decreases from around 33 to 10 mmHg by removing aqueous on average 2.75 microliters/min.
There are also several different glaucoma drainage implants. These include the original Molteno implant (1966), the Baerveldt tube shunt, or the valved implants, such as the Ahmed glaucoma valve implant and the later generation pressure ridge Molteno implants. These are indicated for glaucoma patients not responding to maximal medical therapy, with previous failed guarded filtering surgery (trabeculectomy). The flow tube is inserted into the anterior chamber of the eye and the plate is implanted underneath the conjunctiva to allow flow of aqueous fluid out of the eye into a chamber called a bleb. Ahmed glaucoma valve is freely available in India at present.
The ExPress Mini Shunt
Is a newer, non-valved device that was originally designed to provide a direct conduit from the anterior chamber to the sub-conjunctival space or bleb. In this position it was unstable and tended to erode through the conjunctiva. Now the more common use is as a modification of the trabeculectomy procedure, placed under a scleral flap, replacing the sclerostomy step. (see trabeculectomy).
The glaucoma valve implant is indicated for glaucoma patients not responding to maximal medical therapy, with previous failed guarded filtering surgery (trabeculectomy) or in cases where conventional drainage surgery is unlikely to succeed. Common situations where the use of a glaucoma implant as a primary procedure is indicated include.
❖ Neovascular glaucoma -- glaucoma associated with vascular disease of the eye (often diabetes)
❖ Cases of Uveitis -- acute or chronic inflammation of the eye.
❖ Traumatic glaucoma -- glaucoma associated with injury to the eye.
❖ Silicone glaucoma -- glaucoma due to Silicone used to repair a detached retina.
❖ Infantile / Juvenile glaucoma -- often associated with developmental defects of the eye.