Conjunctival repair after glaucoma drainage device exposure using collagen-glycosaminoglycane matrices

André Rosentreter,Alexandra Lappas,Maged Alnawaiseh,Thomas Stefan Dietlein,Randolf Alexander Widder

doi:10.1186/s12886-018-0721-6

Abstract

BackgroundTo report the results of the repair of conjunctival erosions resulting from glaucoma drainage device surgery using collagen-glycosaminoglycane matrices (CGM).MethodsCase series of 8 patients who underwent revision surgery due to conjunctival defects with exposed tubes through necrosis of the overlying scleral flap and conjunctiva after Baerveldt drainage device surgery. The defects were repaired by lateral displacement of the tube towards the sclera, with a slice of a CGM as a patch, covered by adjacent conjunctiva.ResultSuccessful, lasting closure (follow-up of 12 to 42 months) of the conjunctival defects was achieved without any side-effects or complications in all eight cases.ConclusionsErosion of the drainage tube, creating buttonholes in the conjunctiva after implantation of glaucoma drainage devices, is a potentially serious problem. It can be managed successfully using a biodegradable CGM as a patch.

Highlights

To report the results of the repair of conjunctival erosions resulting from glaucoma drainage device surgery using collagen-glycosaminoglycane matrices (CGM)
In the case of trabeculectomy, especially after use of antimetabolites such as mitomycin-C (MMC) and 5fluoruracile (5-FU), conjunctival defects can even occur a long time after surgery
After implantation of an episcleral glaucoma drainage device (GDD, e.g. the non-valved Baerveldt (Advanced Medical Optics, USA) or the valved Ahmed (New World Medical, USA) etc.), complications such as erosion of the tube (GDD-specific) or even the plate of the implant through the conjunctiva occur in 2–7% cases [1,2,3,4,5]

Summary

Introduction

To report the results of the repair of conjunctival erosions resulting from glaucoma drainage device surgery using collagen-glycosaminoglycane matrices (CGM). Conjunctival defects after penetrating glaucoma surgery, e.g. trabeculectomy or insertion of episcleral glaucoma drainage devices, are rare but severe complications. In the case of trabeculectomy, especially after use of antimetabolites such as mitomycin-C (MMC) and 5fluoruracile (5-FU), conjunctival defects can even occur a long time after surgery. After implantation of an episcleral glaucoma drainage device (GDD, e.g. the non-valved Baerveldt (Advanced Medical Optics, USA) or the valved Ahmed (New World Medical, USA) etc.), complications such as erosion of the tube (GDD-specific) or even the plate of the implant through the conjunctiva occur in 2–7% cases [1,2,3,4,5]. As with late bleb leakage after trabeculectomy, erosion of the conjunctiva exposing the tube of the GDD makes revision surgery necessary [7]. Erosion of the conjunctiva on top of the tube or the implant is more frequent in eyes with a history of multiple intraocular surgeries

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Results

Conclusion