We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency.
Huang MC, Netland PA, Coleman AL, Siegner SW, Moster MR, Hill RA. Intermediate-term clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol 1999 Jan;127(1):27-33.
Smith MF, Doyle JW, Ticrney JW Jr. A comparison of glaucoma drainage implant tube coverage. J Glaucoma 2002 Apr;11(2): 143-147.
Souza C, Tran DH, Loman J, Law SK, Coleman AL, Caprioli J. Long-term outcomes of Ahmed glaucoma valve implantation in refractory glaucomas. Am J Ophthalmol 2007 Dec;144(6):893-900.
Wishart PK, Choudhary A, Wong D. Ahmed glaucoma valves in refractory glaucoma: a 7-year audit. Br J Ophthalmol 2010 Sep;94(9):1174-1179.
Ayyala RS, Zurakowski D, Smith JA, Monshizadeh R, Netland PA, Richards DW, Layden WE. A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma. Ophthalmology 1998 Oct;105(10):1968-1976.
Patel S, Takusagawa H, Shen L, Dohlman C, Grosskreutz C. Long-term complications associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol 2012 Jul;154(1):207-208.
Li JY, Greiner MA, Brandt JD, Lim MC, Mannis MJ. Longterm complications associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol 2011 Aug;152(2):209-218.