Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Glaucoma, Tubes and the Vitreous Base

Barton K.
Glaucoma Uveitis Clinic, Moorfields Eye Hospital, London, United Kingdom

Purpose: To compare the relative indications and advantages of pars plana glaucoma drainage device implantation with the inherent disadvantages of the more invasive procedure.
Method: Pars plana implantation of glaucoma drainage devices is indicated in preference to anterior segment placement in certain types of glaucoma. The relative merits of the two techniques will be discussed with reference to both published literature and highlighted by specific cases from a specialist secondary glaucoma practice.
Results: Indications for pars plana implantation include a shallow anterior chamber or peripheral anterior synechiae. Highly hypermetropic eyes at risk of aqueous misdirection, aphakes and post-keratoplasty glaucoma are also appropriate indications. Long-term IOP control appears to be comparable to that after anterior segment implantation. There is some evidence of improved survival of penetrating keratoplasties in comparison with anterior chamber tube implants. An important requirement of pars plana placement is a peripheral pars plana vitrectomy with careful attention to the vitreous base. Blockage of the implant with peripheral vitreous is a potential cause of IOP elevation and failure.
Conclusions: Less than 10% of glaucoma drainage devices are implanted via the pars plana because of the deterrent effect of an extra and invasive procedure in many cases, despite a number of advantages in terms of ease of implantation and low ris

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