The "Pocket" Technique: A Novel Surgical Technique for Repair of Glaucoma Drainage Device Tube Exposure.

Abstract

Presented is a novel surgical technique, termed the "pocket" technique, of scleral patch graft placement into a subconjuntival pocket to cover exposed glaucoma tube shunts, which is particularly useful in cases of scarred and thinned conjunctiva and Tenons. Exposure of glaucoma tube shunts is an uncommon postoperative complication which poses a significant risk to the patient and may be difficult to repair. In this case series, the authors present 2 cases using a novel surgical technique, the "pocket" technique, to place a scleral patch graft to address tube exposure. Patient 1 remained free of tube exposure at most recent follow-up visit after 21 months, and patient 2 remained free of tube exposure at most recent follow-up visit after 4 months. This technique offers an elegant surgical option that has multiple benefits; it allows for stability of the scleral patch graft even in cases of scarred down, thinned conjunctiva with minimal Tenons, allows for repair along the entire length of the tube shunt including perilimbal exposures, and allows for secondary healing when there is not enough conjunctiva to cover both the opening and the patch. These advantages make the "pocket" technique a quick to perform, minimally invasive surgical approach that is useful for addressing both difficult and straightforward tube exposure cases.