Aqueous shunt implantation places a tube and plate device (glaucoma drainage implant) to divert aqueous humour from inside the eye to a reservoir under the conjunctiva. It is used for complex or refractory glaucoma.
How Shunts Work
The tube is inserted into the anterior chamber or ciliary sulcus, while the plate sits on the sclera under the conjunctiva where a bleb forms. Fluid drains along the tube and diffuses through the surrounding tissues, lowering intraocular pressure.
- Common devices include various valved and non‑valved implants
- Often chosen when trabeculectomy is unlikely to succeed or has failed
- Can be used in eyes with scarring, neovascular glaucoma, or previous surgery
- Post-operative pressure may initially be high or low depending on implant type and ligatures
Long-Term Care
Shunts can control pressure for many years but require lifelong monitoring. Complications include tube blockage, erosion, diplopia, or late failure.
- Topical drops may still be needed to fine-tune pressure
- Patients must attend regular follow-up to check tube position and bleb health
- Prompt attention is needed for redness, pain, or vision change near the implant
- Despite risks, aqueous shunts are invaluable for salvaging pressure control in challenging glaucoma
