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.
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.
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
Why It Is Done
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:
Difficult case of glaucoma and the doctor
thinks that other surgical methods may fail.
Form of glaucoma in
which new blood vessels grow on the colored part of the eye, or iris. This is
neovascular glaucoma and occurs primarily in people
who have diabetes or who have vascular diseases in the eye. It is difficult to
Corneal transplant, which is a surgery to replace the
clear surface on the front of the eye (cornea).
Complications of tube-shunt surgery that may
occur right after surgery include:
High pressure in the eye, causing the space in the front part of
the eye (anterior chamber) to collapse (malignant
Inflammation in the eye.
Bleeding or blood
in the eye (hyphema).
Softening of the eyeball due to fluid loss
Movement of the tube causing it to come in contact with
the clear cover of the eye (cornea), the iris, or the lens. This can affect
vision or proper function of the eye.
Late complications of tube-shunt surgery include:
Scar tissue forming around the device. The
chances of this complication can be reduced if medicines, such as steroids, are
Softening of the eyeball due to fluid loss (hypotony),
leading to clouding of the lens (cataract).
Infection in the
Blood in the eye (hyphema).
Eye muscle imbalance,
resulting in double vision.
What To Think About
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.
ByHealthwise Staff Primary Medical ReviewerAdam Husney, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Specialist Medical ReviewerChristopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
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