The use of implants to drain aqueous from the anterior chamber to a posterior collecting reservoir is an important additional option in the treatment of advanced refractory glaucoma. In the past decade, many problems and complications associated with drainage implants have been solved by modifications in implant design and surgical technique. These include: entry of the tube into an equatorial collecting device, increased surface area of the collecting reservoir, use of a needle track to insert the tube into the anterior chamber, suturing a donor scleral patch to cover the tube, intracameral injection of hyaluronic acid (Healon), ligation of the tube with a temporary suture, and antifibrotic medical therapy. The adoption of some or all of these modifications in recent years has clearly resulted in fewer complications and better long-term control of intraocular pressure.