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Submitted: 2022-09-30
Case Series
Published: 2025-01-27

Scleral patch with amniotic membrane for tube exposure of glaucoma drainage device in a Malaysian tertiary eye centre

Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia; Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia;
Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
autologous serum eye drops glaucoma drainage device scleral patch tube exposure

Abstract

Background: Glaucoma drainage device (GDD) implantation can cause serious complications such as hypotony, tube exposure, and endophthalmitis. This study illustrates the management of tube exposure.

Case series: In primary surgery, all GDD tubes were covered with a donor scleral or a pericardial flap. All cases manifested with a non-leaking conjunctival dehiscence. One eye developed exogenous endophthalmitis which resolved with antibiotic treatment. Another initially had failures with different graft materials and methods, ultimately requiring a scleral patch. A scleral patch was used to cover the exposed tube, further enclosed by a double-layered amniotic membrane using inlay and overlay grafting method. Postoperatively, instillation of autologous serum eyedrops was commenced to promote conjunctival epithelialization. All eyes epithelialized successfully to cover the scleral patch. On the other hand, another developed new conjunctival erosion and ultimately required a new GDD implantation.

Conclusion: A scleral patch graft and a double-layer amniotic membrane transplant supplemented with autologous serum eye drops may be considered in the management of GDD tube exposure.