International Ophthalmology

, Volume 38, Issue 6, pp 2349–2356 | Cite as

“Double scleral tunnel in tandem” technique for glaucoma drainage tube implants

  • Dimitrios BrouzasEmail author
  • Maria Dettoraki
  • Konstantinos Andreanos
  • Nikolaos Nomikarios
  • Chryssanthi Koutsandrea
  • Marilita M. Moschos
Original Paper



To describe a new technique of Ahmed glaucoma valve implantation in patients with refractory glaucoma and present the long-term results.


Twenty-eight eyes of 28 patients with refractory glaucoma participated in the study. “Double scleral tunnel in tandem” technique was used for glaucoma valve implantation in all patients. The technique consists of the formation of two scleral tunnels in tandem so as to completely cover the extraocular part of valve’s tube and facilitate a parallel to the iris placement of the intraocular part of the tube.


Postoperative hypotony developed in two (7.1%) cases which resolved within 3 days in all cases. One (3.6%) eye manifested postoperative hyphema that resolved without complications within a week, and two (7.1%) cases presented with exposure of the tube. The average highest postoperative intraocular pressure (IOP) during the follow-up period was 19 mmHg (range 8–38 mmHg) without medications, and the average IOP at the last follow-up visit was 14.5 mmHg (range 8–22 mmHg). Additional treatment for IOP control was necessary in 11 (39.3%) cases. The average follow-up period was 60 months.


This novel technique was found to be easy to master, effective and with low cost and rate of complications.


Glaucoma valve Tube exposure Glaucoma valve implantation technique Double scleral tunnel in tandem 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol followed the principles in the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all patients.


  1. 1.
    Kiddee W, Trope G (2013) Glaucoma tube imaging using anterior segment optical coherence tomography in patients with opaque cornea. J Glaucoma 22:773–775CrossRefGoogle Scholar
  2. 2.
    Krebs DB, Liebmann JM, Ritch R, Spealer M (1992) Late infectious endophthalmitis from exposed glaucoma setons. Arch Ophthalmol 110:174–175CrossRefGoogle Scholar
  3. 3.
    Raviv T, Greenfield DS, Liebmann JM et al (1998) Pericardial patch graft in glaucoma implant Surgery. J Glaucoma 7:27–32CrossRefGoogle Scholar
  4. 4.
    Tanji TM, Lundy DC, Minckler DS et al (1996) Fascia lata patch graft in glaucoma tube surgery. Ophthalmology 103:1309–1312CrossRefGoogle Scholar
  5. 5.
    Brandt JD (1993) Patch graft of dehydrated cadaveric dura mater for tube-shunt glaucoma surgery. Arch Ophthalmol 111:1436–1439CrossRefGoogle Scholar
  6. 6.
    Freedman J (1987) Scleral patch grafts with Molteno setons. Ophthalmic Surg 18:532–534PubMedGoogle Scholar
  7. 7.
    Seiff SR, Chang JSJ, Hurt MH, Khayam-Bashi H (1994) Polymerase chain reaction identification of human immunodeficiency virus-I in preserved human sclera. Am J Ophthalmol 118:528–530CrossRefGoogle Scholar
  8. 8.
    Thandani V, Penar PL, Parthington J et al (1998) Creutzfeld–Jakob disease probably acquired from a cadaveric dura mater graft. J Neurosurg 69:766–769Google Scholar
  9. 9.
    Brandt JD (1993) Patch grafts of dehydrated cadaveric dura mater for tube—shunt glaucoma surgery. Arch Ophthalmol 111:1436–1439CrossRefGoogle Scholar
  10. 10.
    Ollila M, Falck A, Airaksinen PJ (2005) Placing the Molteno implant in a long scleral tunnel to prevent postoperative tube exposure. Acta Ophthalmol Scand 83:302–305CrossRefGoogle Scholar
  11. 11.
    Chun YS, Kim KW, Kim JC (2013) Autologous tragal perichondrium patch graft for ahmed glaucoma valve tube exposure. J Glaucoma 22:e27–e30CrossRefGoogle Scholar
  12. 12.
    Tamçelik N, Sarici AM, Yetik H et al (2010) A novel surgical technique to prevent postoperative Ahmed valve tube exposure through conjunctiva: tenon advancement and duplication. Ophthalmic Surg Lasers Imaging 41:370–374CrossRefGoogle Scholar
  13. 13.
    Tamcelik N, Ozkok A, Sarıcı AM et al (2013) Tenon advancement and duplication technique to prevent postoperative Ahmed valve tube exposure in patients with refractory glaucoma. Jpn J Ophthalmol 57(4):359–364CrossRefGoogle Scholar
  14. 14.
    Kim D-H, Park C-K, Ahn M-D (2003) Clinical results of Ahmed valve implantation in the aspects of complications. J Korean Ophthalmol Soc 44:888–895Google Scholar
  15. 15.
    Huang MC, Netland PA, Coleman AL et al (1999) Intermediate-term clinical experience with the Ahmed glaucoma valve implant. Am J Ophthalmol 127:27–33CrossRefGoogle Scholar
  16. 16.
    Ayyala RS, Zurakowski D, Smith JA et al (1998) A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma. Ophthalmology 105:1968–1976CrossRefGoogle Scholar
  17. 17.
    Kil YG, Chung DY (1999) Ahmed glaucoma valve implant for neovascular glaucoma. J Korean Ophthalmol Soc 40:1950–1959Google Scholar
  18. 18.
    Ozdamar A, Aras C, Ustundag C et al (2001) Scleral tunnel for the implantation of glaucoma seton devices. Ophthalmic Surg Lasers 32:432–435PubMedGoogle Scholar
  19. 19.
    Kugu S, Erdogan G, Sevim MS, Ozerturk Y (2015) Efficacy of long scleral tunnel technique in preventing Ahmed glaucoma valve tube exposure through conjunctiva. Semin Ophthalmol 30(1):1–5CrossRefGoogle Scholar
  20. 20.
    Stein JD, McCoy AN, Asrani S et al (2009) Surgical management of hypotony owing to overfiltration in eyes receiving glaucoma drainage devices. J Glaucoma 18:638–641CrossRefGoogle Scholar
  21. 21.
    Coleman AL, Hill R, Wilson MR et al (1995) Initial clinical experience with the Ahmed glaucoma valve implant. Am J Ophthalmol 120:23–31CrossRefGoogle Scholar
  22. 22.
    Smith M, Buys YM, Trope GE (2009) Second Ahmed valve insertion in the same eye. J Glaucoma 18:336–340CrossRefGoogle Scholar
  23. 23.
    Robert M-C, Hamel P, Blondeau P, Lesk M (2013) Persistent leak after glaucoma aqueous shunt implantation. J Glaucoma 22:647–651CrossRefGoogle Scholar
  24. 24.
    Park HY, Lee NY, Park CK (2009) Risk factors of shallow anterior chamber other than hypotony after Ahmed glaucoma valve implant. J Glaucoma 18:44–48CrossRefGoogle Scholar
  25. 25.
    Smith M, Buys YM, Trope GE (2009) Replacement of Ahmed aqueous drainage devices in eyes with device-related complications. J Glaucoma 18:484–487CrossRefGoogle Scholar
  26. 26.
    Sarkisian SR (2009) Tube shunt complications and their prevention. Curr Opin Ophthalmol 20:126–130CrossRefGoogle Scholar
  27. 27.
    Minckler DS, Vedula SS, Li TJ et al (2006) Aqueous shunt for glaucoma. Cochrane Database Syst Rev 2:CD004918Google Scholar
  28. 28.
    Hong CH, Arosemena A, Zurakowski D et al (2005) Glaucoma drainage devices: a systemic literature review and current controversies. Surv Ophthalmol 50:48–60CrossRefGoogle Scholar
  29. 29.
    Smith MF, Doyle JW, Ticmey JW Jr (2002) A comparison of glaucoma drainage implant tube coverage. J Glaucoma 11(2):143–147CrossRefGoogle Scholar
  30. 30.
    Kurnaz E, Kubaloglu A, Yilmaz Y, Koytak A, Ozerturk Y (2005) The effect of adjunctive Mitomycin C in Ahmed glaucoma valve implantation. Eur J Ophthalmol 15(1):27–31CrossRefGoogle Scholar
  31. 31.
    Lankaranian D, Reis R, Henderer JD, Choe S, Moster MR (2008) Comparison of single thickness and double thickness processed pericardium patch graft in glaucoma drainage device surgery: a single surgeon comparison of outcome. J Glaucoma 17(1):48–51CrossRefGoogle Scholar
  32. 32.
    Ekici F, Moster MR, Cvintal V, Hu WD, Waisbourd M (2015) Tube shunt coverage with gamma-irradiated cornea allograft (VisionGraft). Clin Ophthalmol 9:751–755CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Dimitrios Brouzas
    • 1
    Email author
  • Maria Dettoraki
    • 1
  • Konstantinos Andreanos
    • 1
  • Nikolaos Nomikarios
    • 1
  • Chryssanthi Koutsandrea
    • 1
  • Marilita M. Moschos
    • 1
  1. 1.First Department of OphthalmologyNational and Kapodistrian University of AthensAthensGreece

Personalised recommendations