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Cataract surgery in the presence of a glaucoma drainage device
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Eyes with glaucoma drainage devices pose a challenge during phacoemulsification because there can be uncontrolled fluidic outflow during surgery.
In order to make modern-day cataract surgery safe, surgeons and engineers have optimized the fluidics of phacoemulsification. This allows us to do efficient surgery in a stable chamber while avoiding surge. But surge is simply the condition when the delicate fluidic balance is disturbed and the outflow of fluid is greater than the inflow. And the glaucoma drainage device increases the outflow.
 An eye with a cataract and a glaucoma drainage device. There was a history of neovascular glaucoma due to diabetes and successful retinal laser and anti-VEGF treatment, resulting in regression of the neovascularization and causing iris fibrosis and ectropion pupillae. |
In eyes with glaucoma drainage devices (or even with trabeculectomies), there are extra sources of outflow: the drainage tube, leakage from the incision and the direct aspiration via the phaco probe. There is only one source of inflow: the hanging bottle of balanced salt solution.
Various techniques can help to stabilize the eye and prevent surge: increasing the inflow by raising the bottle height, adding additional inflow by using an anterior chamber maintainer, lowering the outflow by dropping the flow rate in a peristaltic pump, making the incisions tighter and blocking the flow through the glaucoma drainage device.
This last technique can be achieved by placing a temporary plug in the bore of the tube, injecting a barrier of viscoelastic, ligating the tube or even temporarily removing the tube.
What are your techniques for doing cataract surgery in these eyes?