Glaucoma Drainage Device DODI MAULANA TINJAUAN PUSTAKA.pdf

GDD, Glaucoma drainage device

1. GLAUCOMA DRAINAGE DEVICE
Ophthalmology Department of Faculty of Medicine
Sriwijaya University / Medical Staff Group of
Mohammad HoesinGeneral Hospital
Palembang
2025
Consultant :
dr. M. Usman Salim, Sp.M
Dodi Maulana*
Literature Review

2. INTRODUCTION

3. Glaucoma→agroup of optic nerve disorders marked
by Optic Nerve Head damage & loss of Retinal Ganglion
Cells
Types of glaucoma
•Primary & Secondary
•Open angle and close angle
Treatment Goal: Lower IOP → Medications, Laser,
Surgery (e.g., trabeculectomy, GDD)

4. GDD
➢implanted device to divert aqueous humorfrom the
anterior chamber.
➢Suitable for refractory/complex glaucoma
Benefits
➢Control IOP
➢Slows OppticNerve Damage progression
➢Preserve patient’s remaining vision
GDD Classification
➢Valve and Non-valve

5. To understand about GDD
Purpose

6. ANATOMY

7. Conjungtiva
Conjunctiva
Limbal
Conjunctiva
Limbal
Conjunctiva
Fornix
Conjunctiva
Bulbi

8. Tenon capsule

9. Anterior Chamber
Anterior
Chamber
cornea
Lens
Iris

10. Anterior Chamber Angle

11. Aqueous Humor
Production
•Non-pigmented epithelial cells of the ciliary body
Function
•Maintains IOP and eye shape
•Nutrition supply
•Remove metabolic waste
•Antioxidants transport

12. Trabecular Outfow
•Flow across the trabecular
meshwork, enters Schlemm's
canal, passes through the
collector ducts in the outer
wall of Schlemm's canal, which
drain either directly into the
aqueous veins or into the
vessels of the intrascleral
plexus, which then drain into
the aqueous veins.
Uveoscleral Outflow
•Flows from the anterior
chamberinto the interstitial
space between the ciliary
muscle bundlesand then into
the supraciliary and
suprachoroidal spaces.
•Less correlation with IOP
changes
Aqueous Humor Outflow

13. Aqueous Humor Outflow

14. GLAUCOMA

15. Deffinition
•Glaucomasare group of diseases
causing damage to the optic nerve by
the effect of raised ocular pressure on
the optic nerve head
Classifications
•Open Angle
•Close Angle

17. Congenital Glaucoma
•< 3 years
•Abnormal development of the anterior chamber
angle
•Clinical sign: Buphthalmos, haabs striae, epifora
JOAG
•3-40 years
•10-30% familial form
PEDIATRIC GLAUCOMA

18. Buphthalmos Descemet tear / haab striae
Basic And Clinical Science Course Section 10 Glaucoma. 2025.

19. GLAUCOMA
DRAINAGE
DEVICE

20. first GDD
implantation using
horsehair into the
anterior chamber
1906 1912 1973 1974
Molteno Implant
Anthony
Molteno
Rollet &
Moreau
Silk thread for
translimbal
drainage →
Failed due to
complications
Zorab
Krupin Implant
ivented
Dr. Theodore
Krupin
History
1990 1993 Present
Baerveldt
Glaucoma
Implant
Ahmed
Glaucoma
Valve
AADI, PGI, VGI

21. Valve
•Ahmed Glaucoma Valve
•Krupin Slit Valve
Non-valve
•BaerveldtGlaucoma
Implant
•MoltenoImplant
•AADI
•Paul Glaucoma Implant
•Virna Glaucoma Implant
Classification

22. Feature Valve GDD Non-Valve GDD
Example Ahmed Glaucoma Valve
(AGV)
Baerveldt Glaucoma
Implant (BGI), Molteno
Implant, AADI, PGI, VGI
Valve Mechanism Present Absent
Initial Flow RestrictionYes, with internal valveNone, requires
ligation/ripcord insertion
Risk of Early HypotonyLower Higher (requires ligation to
reduce risk)
IOP Reduction Immediately after surgeryDelayed (after 4–6 weeks,
capsule formation)
Hypertensive Phase More common Less common
Comparison Between Valve and Non-valve

23. Long-term IOP Control Good, though slightly lower
than non-valved GDD
according to some studies
Slightly better according to
some studies
Need for IOP-Lowering
Medications
May require more
medications than non-valve
May still need some
medications
Complications Risk of encapsulation and
hypertensive phase
Risk of hypotony, tube
erosion, and diplopia
Plate Material Polypropylene, silicone,
polyethylene
Silicone, polypropylene
Preferred Indication Patients prone to hypotony
(e.g., uveitis, low AH
production)
Patients requiring lower
IOP, not at high risk of
hypotony
Surgical Complexity Easier (no ligation) More difficult
(ligation/ripcord needed)
Encapsulation Rate Higher (40–80%) Lower (20–30%)
Cost Generally more expensiveGenerally more affordable

24. Valve GDD
Ahmed Glaucoma Valve
•Developed by Mateen Ahmed
•Made from medical grade silicone and
polypropylene
•Has 2 versions: rigid and flexible
•Consist of 3 parts, plate, tube, and valve
•Valve closes when IOP < 8 mmHg
•FP 7 (adult) & FP 8 (pediatric)

25. Rigid
Flexible
(latest)
New Worl Medical Brocure

26. Krupin Slit Valve
•Developed in 1974
•Made from medical grade silicone
•Valve Opens IOP >10 mmHg and closes IOP <
8 mmHg
•Only one version (no pediatric)
•Plate area 184 mm
2
Glaucoma Drainage Devices A Practical Illustrated Guide 2019

27. Non-valve GDD
MoltenoImplant
•Developed in 1969
•Made from polypropylene (plate) and silicone
•Has 2 models single and double plate
•Plate area 134 mm
2
(single plate) & 268 mm
2
(double plate)

28. Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

29. BarveldtGlaucoma Implant
•Developed in 1990
•Consist tube and plate made from silicone
•Plate area 250-350 mm
2
•Has wide plate area →Effective IOP reduction

30. www.aao.org/education/image/aqueous-shunts-2.

31. Paul Glaucoma Implant
•Developed in 2019
•Smaller tube diameter than previous GDD
•Plate area 342,1 mm²
•Made from medical grade silicone

32. https://eyewiki.org/Paul_Glaucoma_Implant
.

33. AurolabAqueous Drainage Implant (AADI)
•Developed in 2013, in India
•Based on BaerveldtImplant
•Consist of plate and tube, made from medical grade
siliicone
•Plate area 350 mm²

34. Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

35. Virna Glaucoma Implant
•Developed by Dr. dr. Virna Dwi Oktariana
Asrory, Sp.M(K)in 2019
•Made from polymethylmethacrylate(PMMA)
and silicone.
•VGI GL 51 (adult) and VGI GL 52 (pediatric).
•70-80% effective in controlling IOP.
Low-cost new glaucoma drainage device in Indonesia: one year follow-up of 252 subjects 2019

36. https://rohtolab.com/ophthalmic/product/other/virna-glaucoma-
implant-by-rohto-gl--51Low-cost new glaucoma drainage device in Indonesia: one year
follow-up of 252 subjects 2019

37. Indications and Contraindications
Indications
•Patients with failed
trabeculectomy/multiple failed glaucoma
surgeries
•Secondary glaucomasuncontrolled on
maximal tolerated medical therapy
•High risk of failure of conventional
glaucoma filtration surgery
Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

38. Contraindications
1.Low visual prognosis (hand movement or
light perception)
2.Very thin sclera, staphylomatouseyes
involving >270°of the eye
3.Phakic patients with shallow anterior
chamber
4.Patients who have a flat anterior chamber
with no posterior view
Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

39. Precedure
1.GDD is generally implanted in the superotemporalquadrant of the
eye.
2.The eye is sterilized, and a traction suture is placed on the cornea or
limbus.
3.Conjunctival peritomy and dissection of the sub-Tenon’s space (up
to 8 mm posterior to the limbus) are performed.
4.Identify adjacent rectus muscles and insert the end plate between.
for certain types of GDD (BGI, AADI), the superior rectus muscles
needs to be isolated and lifted to place the plate wings under them
(at least 0.5mm posterior to rectus muscle).
5.Valve GDD required priming with normal saline. Non valve GDD
required modification (ridcordor external ligation, and fenestrated).

40. 7.GDD plate is placed in the sub-Tenon’s space about 8 mm from the
limbus and sutured to the sclera with care to avoid perforation.
8.Sclerotomy is created using a 24G or 25G needle for tube insertion.
9.Tube tip placement options
-Anterior Chamber (AC)–the most common method.
-Ciliary sulcus–aphakia, pseudophakia, shallow AC, or post-
corneal transplant.
-Pars plana-used in anatomically complex eyes.
10.The tube is covered with a square scleral flap (approximately 4 mm).
11.The plate is secured with 10-0 nylon sutures.
12.The scleral flap and conjunctiva are sutured.
13.Antibiotic and steroid eye drops are administered

41. Complications
Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

42. Prognosis
•Effective in controlling IOP and reducing the need of
IOP lowering medications
•Prevents the progression of optic nerve damage
•Does not improve vision
Glaucoma Drainage Devices A Practical Illustrated Guide 2019.

43. Follow Ups and Care
➢Early hipotony
⚫1–4 weeks (edema of the conjunctiva, prevent infection,
reduce inflammation, & lower IOP)
➢Hipertensivephase
⚫Related to wound healing process
⚫Encapsulation of the plate
⚫3-6 weeks, can last up to 4-6 months
➢Stable IOP
⚫Follow up every 3-6 months, or

44. CONCLUSION

45. •Glaucoma = optic nerve damage, usually due to increased intraocular
pressure (IOP)
•Leads to visual field lossand possible blindnessif untreated
•Diagnosis: not just IOP → includes optic nerve evaluation& visual field
test
•Classification by cause:
Primary glaucoma
Secondary glaucoma
•Classification by angle:
Open-angle glaucoma
Angle-closure glaucoma

46. •GDD diverts aqueous humorfrom anterior chamber to subconjunctival
space
•Used in complex/refractory glaucoma(e.g., uveitic, pediatric, high-risk
cases)
•Types:
-Valve-type: Ahmed, Krupin
-Non-valve: Molteno, Baerveldt, AADI, Paul, Virna
•Non-valve GDD → higher risk of early hypotony→ use ligature suture
technique
•Success rate: 70–89% in controlling IOP
•Reduces medication need
•Possible complications: hypotony, corneal edema, tube exposure/migration,
infection
•Proper follow-uphelps manage complications effectively

47. THANK YOU