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Tube-shunt surgery (seton glaucoma surgery) involves placing a flexible plastic tube with an attached silicone drainage pouch in the eye to help drain fluid (aqueous humor) from the eye. This type of surgery is usually done after a trabeculectomy that failed. If a person already has or is likely to form scar tissue in the eye, this type of surgery may be done at the start.
Tube-shunt surgery can be done with the person asleep (general anesthesia) or with anesthetic applied only to the eye (local anesthesia).
The person does not have to be admitted to the hospital. But children may stay in the hospital overnight following surgery. And in some cases, your doctor may recommend that you stay in the hospital overnight following surgery.
The person usually sees the doctor within a day after tube-shunt surgery and 2 to 5 other times during the 6 weeks after surgery, depending on the person's recovery.
Initially after surgery, antibiotics may be applied to the eye. Antibiotics may also be injected under the lining of the eyelid (conjunctiva) at the time of the surgery. At the end of surgery, the eyelid is usually taped shut, and a hard covering (eye shield) is placed over the eye. Corticosteroid medicines are usually applied to the eye for about 1 to 2 months after surgery to reduce inflammation in the eye.
Physical activity that might jar the eye needs to be avoided after surgery. For several weeks after surgery, the person usually needs to avoid bending, lifting, or straining.
After surgery, people who have problems with constipation may need to take laxatives to avoid straining while trying to pass stools. Straining can raise the pressure inside the eye. Your doctor may suggest wearing a shield at night to avoid rubbing the eye when you sleep.
Tube-shunt surgery is most often used for people who have had previous trabeculectomy surgery that was not successful, usually due to scarring.
Tube-shunt surgery is also frequently used to treat glaucoma when a person has a:
More than half of tube-shunt surgeries are successful. This surgery has been shown to reduce intraocular pressure (IOP) and the need for further glaucoma treatment.footnote 1
Complications of tube-shunt surgery that may occur right after surgery include:
Late complications of tube-shunt surgery include:
Tube-shunt surgery is not often used as a first treatment for glaucoma. The advantage of tube-shunt surgery for glaucoma is that there is less chance of severe scarring that can block the drainage opening. This can be an important consideration for people who have had prior surgery for glaucoma that did not work. But the complications from tube-shunt surgery can be serious too.
Gedde SJ, et al. (2009). Three-year follow-up of the tube versus trabeculectomy study. American Journal of Ophthalmology,148(5): 670–84.
Current as of: December 17, 2019
Author: Healthwise StaffMedical Review: Adam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineChristopher Joseph Rudnisky, MD, MPH, FRCSC - Ophthalmology
Current as of: December 17, 2019
Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Christopher Joseph Rudnisky, MD, MPH, FRCSC - Ophthalmology
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