The implant should be examined and primed prior to implantation. Priming is accomplished by injecting 1cc balanced salt solution or sterile water though the drainage tube and valve, using a blunt 26 gauge cannula.
A fornix-based incision is made through the conjunctiva and Tenon's capsule. A pocket is formed at the superior quadrant between the medial or lateral rectus muscles by blunt dissection of Tenon's capsule ffrom the episclera.
The valve body is inserted into the pocket between the rectus muscles and sutured to the episclera. The leading edge of the device should be at least 8-10mm from the limbus.
The drainage tube is trimmed to permit a 2-3mm insertion of the tube into the anterior chamber (AC). The tube should be bevel cut to an anterior angle of 30° to facilitate insertion.
A paracentesis is performed, and the AC is entered at the limbus with a sharp 23 gauge needle, parallel to the iris. Caution: Care must be taken to insure that the drainage tube does not contact the iris or corneal endothelium after insertion.
The drainage Tube is inserted into the AC approximately 2-3mm, through the needle track and parallel to the iris. The leading edge of the device should be 8-10mm from the limbus.
The exposed drainage tube is covered with a small piece of preserved donor sclera or pericardium, which is sutured into place, and the conjunctiva is closed.
NOTE: As an alternative to Step 7, a 2/3 thickness limbal-based scleral flap may be made. The tube is inserted into the AC through a 23 gauge needle puncture made under the flap and the flap is sutured closed.
