Glaucoma Drainage Device (Tube) Surgery
What is glaucoma drainage device (tube) surgery?
A glaucoma drainage device is a small, specially designed device that is implanted to reduce eye pressure. There are two main parts to the device, a tube and a plate.
During surgery, the silicone tube is inserted into the front chamber of the eye through a small hole. The other end of the tube is attached to the plate. The plate is attached to the white wall (sclera) of the eye and is covered by the conjunctiva (transparent covering of the eyeball).
The tube drains fluid from inside the eye to the plate outside the eye. The plate acts like a reservoir for this fluid. The drained fluid is then slowly absorbed by the body.
This implant is designed to be left in your eye for life and does not need to be removed unless there are special reasons to do so.
The anti-scarring medication, mitomycin-C, may be applied during the surgery. Donor tissue may also be used to reinforce the eye surface (covering) over the tube to prevent erosion and exposure.
This surgery is done as a day surgery procedure so you can go home on the same day. The surgery takes about 60-90 minutes. Before the surgery, the surgeon and anaesthetist will administer local anaesthesia (with sedation) or general anaesthesia.
Why do I need this procedure?
Your doctor has diagnosed you with glaucoma and informed you that if left untreated, it is very likely that you will experience irreversible vision loss.
Your doctor has advised that glaucoma drainage device surgery is necessary to help control the pressure in your eye. This surgery involves the implantation of a glaucoma drainage device in your eye. The purpose of the surgery is to achieve good eye pressure control and preserve your current vision. Any vision already lost to glaucoma cannot be restored.
There is no guarantee that the surgery will control your eye pressure in the long term. You may still need to resume eye drops and/or further treatment may be necessary.
What are the precautions?
Before surgery:
• Continue your glaucoma medications up to the day of surgery
• If you are on anti-platelet or anti-coagulant medication, you will have to stop these prior to surgery. Your doctor will advise you accordingly
After surgery:
• Use your eye drops and other medications as instructed and attend eye reviews with your doctor as arranged
• Use an eye shield while sleeping for 3 weeks after surgery
• Avoid eye exposure to tap water for 2 weeks after surgery
• Avoid strenuous activities for 2 months after surgery
• Do not go swimming unless your doctor has informed you it is safe to do so
How is the procedure performed?
The procedure is done as a day surgery. You will have to fast for 6 hours prior to your surgery time. Either general anaesthesia or regional anaesthesia will be used to keep you comfortable.
You will be lying on the operating table whilst the surgery is performed, as described above. Thereafter, you will be monitored for 1 to 2 hours before being discharged home.
What are the risks and complications of the procedure? Not every conceivable complication can be covered in this form, but the following are examples of risks encountered with a glaucoma drainage device surgery
• Infection: Rare but treatable. Severe infections can result in permanent visual loss
• Bleeding: In the front or rarely, back of the eye
• Vision: Some patients will find their vision is not quite as sharp after surgery. The surgery aims to slow down the rate of deterioration caused by glaucoma and cannot guarantee to stop the loss of vision in your eye. Glaucoma surgery carries a small risk that vision may become worse or the eye may become blind after the surgery (wipe-out), although this is rare
• Cornea (clear front wall of the eye): There is a small chance the tube may rub on the inner surface of the cornea. Over time, this may cause the cornea to become cloudy. This may require further surgery to reposition the tube. Rarely in extreme cases, a cornea transplant may be required
• Cataract formation
• Tube/plate-related complications
• Tube block
• Tube erosion
• Movement of the implant
• Double vision
• Droopy eyelid (ptosis) on the side of the operation
• Eye discomfort: It is normal to feel some discomfort and mild pain after surgery due to the presence of some stitches. However, this should very quickly subside but in some cases, it may persist for up to 4 weeks. You may also have some tearing and be sensitive to light for a short time. Care should be taken to avoid rubbing the eye
• Operation failure requiring further treatment
• Anaesthesia risk
• General anaesthesia – heart attack, stroke.
• Regional anaesthesia – injury to the eyeball, optic nerve injury, bleeding
What can I expect after the procedure?
• You can expect to be followedup closely for the first few weeks after surgery
• Your quality of vision may reduce or fluctuate for 1 - 2 months before stabilising
• You may experience some eye discomfort and mild pain for a few days due to stitches in the eye, but this should subside over a few days or weeks
• You will be given steroid and antibiotic eye drops to apply at home for 3 - 4 months. Your need for additional glaucoma eye drops will be advised by your doctor
What are the other options?
Your glaucoma specialist is the best person to give you an idea of the other options available to you apart from this surgery and what would happen if you do not undergo the procedure
What will happen if I do not undergo the procedure?
There is a risk of progressive vision loss or blindness if your eye pressure is not well controlled.
DISCLAIMER: This information sheet mentions some of the more common or important risks of surgery/ procedure. This list is NOT meant to be, and CANNOT be exhaustive.
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This brochure was developed together with NHG Eye Institute partners.
Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group in the north of Singapore. It comprises Khoo Teck Puat Hospital, Yishun Community Hospital and community extensions such as Admiralty Medical Centre and Wellness Kampung. Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg
The information is correct at the time of printing and subject to revision without further notice.