Baerveldt drainage shunt with scleral patch graft and cataract extraction

Abstract

In patients with both cataract and uncontrolled glaucoma, the ophthalmologist may choose to treat both conditions in the same operative encounter. Combined cataract extraction, IOL implantation, and glaucoma shunt surgery offer the patient visual rehabilitation, better control of glaucoma, and the benefit of not having to return to the OR for a second procedure. Additionally, patients with scarred, friable, or otherwise compromised conjunctival tissue may benefit from the use of a glaucoma shunt device, as their conjunctiva may not be viable for creation of a trabeculectomy bleb. Also, the use of shunt devices as a primary glaucoma procedure is on the rise. The use of a non-valved implant such as the Baerveldt has been shown to offer better long-term IOP control, but the choice of valve often falls into the preference of the surgeon and the ability of the patient to tolerate suboptimal IOP over the first 6 postoperative weeks and a higher complication rate with a valved implant (i.e., Ahmed glaucoma valve drainage device).