Removal of Glaucoma Drainage Implant

During enucleations and eviscerations, all periocular foreign bodies should be removed, most commonly glaucoma drainage implants and scleral buckles.  I prefer to remove the implants early in the surgery.  For glaucoma drainage implants, removal usually results in deflation of the eye.  Since these are usually blind, painful eyes with no evidence of malignancy, I would usually be performing an evisceration.  Scleral buckles can sometimes be challenging to remove, depending on the way in which the surgery was performed.  If non-absorbable suture was used, I do prefer removing this suture rather than leaving it attached to the eye, as I believe nonabsorbable sutures can be a nidus for implant exposure for eviscerations.

This is Richard Allen at oculosurg.com.  This video demonstrates removal of a glaucoma drainage implant at the time of evisceration surgery.  I believe that all periocular foreign bodies should be removed at the time of enucleation or evisceration.   A 360 degree conjunctival peritomy is performed and the implant is exposed superiorly.  The conjunctiva in these cases can be thin and adherent to the globe due to previous surgery.  Dissection is carried out subconjunctivally along the anterior surface of the implant.  The tissue can be adherent to areas of the previously placed sutures.  Blunt Westcott scissors are then used to dissect beneath the implant along the surface of the sclera.  The tube is prolapsed from the eye, which can result in the eye deflating.  The medial and lateral edge of the implant are identified and dissected from the adjacent tissue.  Additional dissection is carried out on each side of the implant.  At times, you can encounter a large reservoir.  There are suture holes with adherent scar or sutures that need to be released.  Once the implant is freed, it is sent to the pathologist for gross examination and the remainder of the surgery can proceed.