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Abstract #120976 Published in IGR 25-1
Same-quadrant tube exchange and multiple-layer closure for recurrent tube erosion: Surgical technique description and preliminary results
Armstrong M; Wang J; Gorla M; Qiu MAmerican journal of ophthalmology case reports 2024; 36: 102138
PURPOSE: This 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. OBSERVATIONS: We 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. CONCLUSIONS: In 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.
Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, USA.
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