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Glaucoma Drainage Valve Implantation

What is Glaucoma Tube Shunt surgery ?

Glaucoma tube shunt surgery is when a tube like device gets implanted in the eye. This device needs to equalise pressure inside the eye with the pressure outside. This surgery is a an advanced glaucoma surgery because this would advised in those patients who have advanced glaucoma. 

There are many types of devices for eg tubes, stents, biomedical tissues etc. We have covered the types later in this article. Advanced glaucoma surgery is a fast growing field in glaucoma care. It is very important to be up to date with the latest techniques and trends. At eye solutions we perform the most advanced techniques in glaucoma surgery. 

Who needs advanced glaucoma surgery ?

Glaucoma tube shunt surgery is necessary if you have glaucoma that is not controlled with medicines or a trabeculectomy. You would need this type advanced glaucoma surgery if the eye pressures are high because of or inspite of :

  1. Your eyes have gone through many surgeries.

  2. Trabeculectomy failed.

  3. Severe inflammation of the eye which does not heal with medications.

  4. You have suffered from blunt injury to the eye. 

Though this surgery is usually used as a last resort in management of glaucoma it has a better success rate. The reason it is the last resort is because the post operative care and management is lengthy and can be tedious for the patient. 

What are the types of glaucoma tube shunt surgery ?

There are 3 types of advanced glaucoma surgery:

Tubes : In this procedure a tube goes into the eye. This tube is already connected to a plate which is outside the eye. The tube drains fluid from inside to the plate outside and thus equalises pressure in the eye. There are many tubes in the market. Some of the older ones caused many problems like over drainage of fluid from the eye making the pressure very low. At Eye solutions we use the most advanced tube which has an internal valve. This valve prevents over filtration and maintains a normal pressure at all times. This tube is the Ahmed glaucoma valve. 

Stents: Stents are tiny microscopic devices inserted in the drainage channel of the eye. They help drain fluid out of the eye by bypassing the normal drainage channels. Unlike tubes there is no connection between the inside and outside of the eye. This method is more prevalent in the west as it is very costly. Many times a single stent is not enough in which case many stents gets used. Read here to understand how stents work.

Biomedical tissue: also known as the Xen Gel Implant. This is a tube made of collagen which is 6 mm long and injected inside the eye. The other end of the tube comes out of the eye and helps equalise pressure. This technique is still in the research phase in India. Know more about Xen Gel Implant.

Amongst all the techniques mentioned the Ahmed glaucoma valve surgery is the safest and most successful in managing the condition.

What care one should take after glaucoma tube shunt surgery ?

  1. Strict cleanliness, no touching the eyes

  2. Water should not enter the eyes

  3. Using sterile cotton to clean the eyes. 

  4. No applying pressure to the eyes. This can make the eye pressure very low which will affect the other structures in the eye 

  5. Using medications as advised by the doctor

What to expect after glaucoma tube shunt surgery ?

Between day 1 and day 7 :

  1. Eye pain and irritation. This is due to the sutures placed in the eye and the eye adjusting to the plate which is now placed on the eye. With medication these symptoms are well taken care.

  2. Low eye pressure: Called as the hypotonic phase. It is very common to have eye pressure fall down in the first 7 days before it normalises.

Between day 7 and day 60:

  1. High eye pressure: Called as the hypertonic phase. Gets managed with eye drops till the pressure equalises on its own. In some cases the eye drops for a long period of time is necessary.

  2. Mild irritation: this is due to the sutures which are absorbing. 

What is the cost of this advanced glaucoma surgery ?

Back to the question about advanced glaucoma surgery cost in Mumbai. As mentioned earlier here we place a certain device on the eye to help in reducing the pressure.   The post surgery care involves many visits to the eye doctor.  

At Eye Solutions, we have tried to create packages where our patients don’t have to keep paying us every time they come to hospital.  They pay us one fee and don’t pay us for upto two months after surgery for all the post surgery visits. Depending on the device used our packages from Rs 50000-80000 which includes the cost of the valve and its shipping. Please feel free to contact us for further details.

Frequently Asked Questions

It equalises the pressure between the inside and outside of the eye via the tube that drains fluid from the inside to the reservoir outside so the pressure of the eye becomes normal.

This surgery is advisable when all modes of treatment like medications, filtration surgery and laser treatment have failed.   Once your glaucoma specialist advises you to undergo this surgery the sooner the surgery done the sooner there is a possibility of the pressure getting under control.

  1. Strict cleanliness, no touching the eyes, water should not enter the eyes and only using sterile cotton to clean the eyes. 
  2. No applying pressure to the eyes as this can bring the eyes pressure very low which will affect the other structures in the eye 
  3. Using medictaions as advised by the doctor 

Post surgery it is important that the patient comes for follow up every 2 days for the 1 st week as this is the crucial period during which the connection made in the eye heals.

The doctor will check if the pressure inside the eye is not too high or not too low and accordingly alter the managment post op.

Sometimes an injection in the eye is necessary post op to keep the connection open if the doctor feels it is getting blocked due to the healing process. 

Patient will feel mild irritation due to sutures in the eye but that is only temporary. 

This surgery is to make sure that the part of the optic nerve that has not got damaged by the raised pressure doesnt get damaged further. It is a surgery that preserves vision rather than improves it. 

Unfortunately the part that has already damaged is permanent as nerves once damaged can not revive.

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