Same-quadrant tube exchange and multiple-layer closure for recurrent tube erosion: Surgical technique description and preliminary results

Abstract

PurposeThis report describes a surgical approach involving a 5-layer closure performed for a patient with uveitic glaucoma who had an Ahmed Glaucoma Valve placed 12 years prior to presentation, then erosions which were revised 2 and 4 years ago. Additionally, the patient had a Descemet Stripping Endothelial Keratoplasty (DSEK) completed 4 years prior to presentation. The patient presented with a tube that was eroded and a DSEK that had failed. ObservationsWe describe the process of same-quadrant tube exchange for a new Baerveldt Glaucoma Implant-350 with repositioning of the tube tip from the anterior chamber to the ciliary sulcus with a 5-layer closure with Tutoplast pericardial patch graft, capsule autograft harvested from the Ahmed capsule, Tenon's transposition from a different quadrant, Tenon's advancement from the same quadrant, and conjunctival advancement. By post-operative month 16, the patient had undergone a repeat DSEK and had an improved visual acuity and well-controlled intraocular pressure on one IOP-lowering medication. ConclusionsIn complex tube revision surgeries with melted sclera, difficult closure under tension, and/or presence of significant tissue defect, pericardial patch graft, capsule autograft, tenon's transposition, tenon's advancement, or conjunctival advancement should be considered, as needed.