A Novel Technique for Recurrent Tube Exposure Repair

Abstract

Purpose. Tube exposure can lead to vision-threatening consequences and requires prompt surgical attention. Posterior repositioning of the tube to the pars plana has previously been reported as a successful technique. However, this method requires a pars plana vitrectomy (PPV). Here, we describe a novel technique of repositioning the tube into the ciliary sulcus without requiring PPV. Methods. This is a retrospective interventional case report of two patients who had undergone prior glaucoma drainage device implantation and prior tube exposure repair and developed recurrent tube exposure. Tube exposure in the subjects was repaired by repositioning the tube in the ciliary sulcus. Results. The two eyes remained exposure free postoperatively with 51- and 60-month follow-ups. Conclusions. Repositioning the tube to the ciliary sulcus may be an effective technique to avoid reexposure.

Glaucoma drainage implant exposure: A review of aetiology, risks and repair considerations

“…As such, following tube or implant exposure, in the absence of infection, relocation of the implant or redirection of the tube avoiding these high‐risk areas should be considered. Some studies have also described posterior repositioning of the tube into pars plana or ciliary sulcus 66,67 . Posterior positioning of the tube reduces the amount of extraocular exposure of the tube, thereby reducing risk of exposure.…”

“…Kang et al discussed extracting and redirecting the exposed tube towards the ciliary sulcus, with the tube entering the sulcus space 4 mm from limbus. In the method described, viscoelastic was used to create space in the ciliary sulcus for the insertion of the tube and no pars plana vitrectomy was required 66 …”

“…Some studies have also described posterior repositioning of the tube into pars plana or ciliary sulcus. 66,67 Posterior positioning of the tube reduces the amount of extraocular exposure of the tube, thereby reducing risk of exposure. To aid the placement of the GDI pars plana, some studies have discussed the use of a pars plana clip, although to our understanding, this is still controversial.…”

“…In the method described, viscoelastic was used to create space in the ciliary sulcus for the insertion of the tube and no pars plana vitrectomy was required. 66 Nardi et al published a case series describing a new technique involving the creation of a scleral tunnel using a 19G blade, 3 mm from the limbus, and at an angle of 30 -45 from the original track and oblique to the central axis of the implant plate. A 23G needle was then inserted into the new oblique scleral tunnel and entered into the anterior chamber and the tube was inserted into the AC using the needle track.…”

Tenon Cyst Patch Graft for Ahmed Glaucoma Valve Tube Exposure: Case Series Report

“…Removal or relocation of the GDD, along with replacement of the patch graft, has been proposed as an effective repair method with different success rates, depending on the technique reported 13…”