A Case Series and Systematic Review: Results of Surgical Management of Glaucoma Drainage Device Tube Exposure

Nutnicha Neti; Sakaorat Petchyim; Theerajate Phongsuphan; Ngamkae Ruangvaravate; Pinnita Prabhasawat; Darin Sakiyalak; Naris Kitnarong; Anuwat Jiravarnsirikul

doi:10.33192/smj.v76i12.270377

Authors

Nutnicha Neti Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sakaorat Petchyim Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Theerajate Phongsuphan Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Ngamkae Ruangvaravate Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Pinnita Prabhasawat Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Darin Sakiyalak Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Naris Kitnarong Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Anuwat Jiravarnsirikul Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v76i12.270377

Keywords:

Glaucoma drainage device, Glaucoma tube, Glaucoma shunt, Expose, Treatment

Abstract

Objective: To present a case series of patients who underwent surgical repair for glaucoma drainage device (GDD) tube exposure and conduct a systematic review to analyze results of various surgical techniques.

Materials and Methods: This study provides the details of GDD tube exposure repair at our hospital. Additionally, a systematic review was conducted using electronic databases including EMBASE, MEDLINE, and CENTRAL. Data extraction and analysis included demographic information, surgical techniques, results, and duration of follow-up.

Results: We reported nine cases of GDD tube exposure repair, with additional 109 cases from 24 previous studies. One of our challenging cases encountered multiple tube revision failures by the patch graft technique; the exposure issue was sustainably resolved by a hinge scleral flap with buccal mucosal graft technique. Of the 118 cases, various surgical techniques were used, including patch grafts, hinge scleral flaps, primary conjunctival closure and rerouting. Among the cases, 61.6% were classified as difficult cases. The overall first, fifth and thirteenth-year survival rate
was 90.7%, 86.2% and 86.2%, respectively. Rerouting and scleral flap/tunnel techniques demonstrated the highest survival rate. No statistically significant differences in survival outcomes were observed among patch graft, scleral flap/tunnel and rerouting method (P = 0.129). The mean survival duration was 33.54 months. The duration of follow-up was 35.01 months.

Conclusion: Surgical management of GDD tube exposure yields favorable outcomes. A hinge scleral flap with buccal mucosal grafts can be a good option to treat challenging cases. The findings can shape an algorithm to manage GDD tube exposure.

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