Step 1.
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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.
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Step 2.
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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.
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Step 3.
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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.
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Step 4.
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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.
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Step 5.
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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.
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Step 6.
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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.
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Step 7.
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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.
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Alternative Step 7.
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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.
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