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A Novel Surgical Technique For Closure of Dehiscence Conjunctiva Due to Glaucoma Drainage Device

Our aim is to describe a novel surgical technique for dehiscence conjunctiva caused by glaucoma drainage devices not responsive to conventional closure methods. There has been a significant rise in the implementation of glaucoma drainage devices for the surgical treatment of glaucoma; this has required surgeons to deal with their many limitations. One common unwanted occurrence is the postoperative extrusion of such tubes or plates through eroded conjunctiva. This can have catastrophic implications and leaves this cohort of patients at high risk of endopthalmitis. There remains a significant paucity on guidance in literature best describing optimal surgical techniques when attempting to deal with this unwanted complication. We describe a modified technique successfully implemented by our institution achieving consistent outcomes in even the most complex cases. We describe a modified surgical method involving a combination of relieving conjunctival incisions, tutoplast, conjunctival autograft, and amniotic membrane. We illustrate its implementation on a case example in a patient with a complex ocular history including, keratouveitis, dry eyes, and previous Baerveldt tube insertion presenting with externalization of plate. A combined surgical closure method should be adopted in complex cases when failure of direct closure will almost be inevitable.

Posted: 9/27/2018