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Baerveldt glaucoma drainage device (GDD) implantation

Webinar Description

Presenter: Seng Kheong Fang

Operative technique of implantation of a non-valved Glaucoma Drainage Device (Baerveldt) with flow restrictive measures

  1. Ensure adequate anaesthesia, usually peribulbar local anaesthesia
  2. Choose appropriate quadrant, depending on the state of conjunctiva, usually supero-temporal quadrant
  3. Fornix based conjunctival peritomy, usually 3 clock hours, hemostasis secured
  4. Horizontal (medial) recti and vertical (superior) recti isolated and space created under the muscle
  5. 0.02% Mitomycin C soaked pledgets placed between Tenon’s capsule and sclera in between the recti usually for 3 minutes and washed away with BSS
  6. Plate of Baerveldt implant inserted underneath the recti and anchored with non-absorbable sutures, usually 8/0 nylon
  7. Flow restrictive measures (to prevent immediate post operative hypotony) can be intra-luminal stent with 3/0 prolene or external ligature, but my preferred technique is single 7/0 vicryl tie near the junction of the plate with complete occlusion
  8. Sherwood slits, usually at least a dozen is made distal to the ligature to promote initial flow of aqueous
  9. Tube is then trimmed to adequate length and inserted into the AC via a 23-G needle track usually entering about 2 mm from the limbus, making sure its not too close to the cornea (usually should be below Schwalbe’s line) and not too near the iris and lens
  10. Tube anchored with 10/0 nylon and covered with donor sclera or corneo-sclera or pericardium or Tutopatch.
  11. Watertight conjunctiva closure with continuous 8/0 vicryl sutures

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