![]() Surgical techniqueįollowing peribulbar anesthesia and corneal traction suture, a fornix-based conjunctival flap was created in superior temporal quadrant (STQ). A high IOP on MMT, with two failed trabeculectomies and an advanced glaucomatous cupping prompted us to urgently plan an AGV implantation, but to eliminate the risk of potential transmission, an intra-scleral route was adopted which was graft-free. Near total cupping of the optic disc was noted on dilated fundus examination. Gonioscopy revealed scarred stomas with open angles. Examination of OD showed hazy cornea with epithelial edema, IOL in place, failed flat blebs and superior 200 degree of peri-limbal fibrosis. The corrected distance visual acuity (CDVA) was 20/200 and 20/80 for OD and OS respectively, and the IOP was 40 mm Hg in OD and 11 mm Hg in OS on topical beta-blocker, alpha-agonist, prostaglandin analog and topical and oral carbonic anhydrase inhibitor. Previous surgical history included cataract surgery with intra-ocular lens (IOL) implantation in OD, trabeculectomy done twice in OD and once in OS. Case ReportĪ 63-year-old woman presented to our institute with painful diminution of vision in right eye (OD) since 1 month. We showcase a modified technique of graft-free insertion of the AGV tube (AGV model P7, New World Medical Inc, Rancho Cucamonga, CA, USA) through an intra-scleral sleeve. Though glaucoma drainage devices (GDDs) remain the mainstay of management in eyes with refractory glaucoma, its implantation in the prevailing COVID-19 pandemic has become a challenge in the light of potential transmission of SARS-CoV-2 through the donor scleral graft, used to cover the AGV tube. ![]()
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