J Korean Ophthalmol Soc.  2016 Mar;57(3):453-460. 10.3341/jkos.2016.57.3.453.

Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

• Kim SW
• Kim YH
• Yun IS
• Ahn JH

• KMID: 2213247
• DOI: http://doi.org/10.3341/jkos.2016.57.3.453

Abstract

PURPOSE
To report serial cases of patients who received surgical treatment for tube erosion after Ahmed valve implantation.
METHODS
In this retrospective and longitudinal study, surgical outcomes of reconstruction for tube erosion after Ahmed valve implantation were evaluated. Tube erosion occurred in 7 of 125 eyes (121 patients) at 60.5 ± 67.5 months (2 to 196 months). To prevent recurrence of tube erosion, the tube was repositioned backward in 4 eyes. Scleral allograft was used in all cases. Partial thickness scleral flap, collagen matrix implant, or bovine pericardium was used to cover the exposed tube in selected cases. In eyes with large conjunctival defects or severe adhesions between surrounding conjunctiva and episclera, rotational conjunctival flap, conjunctival autograft, or amniotic membrane graft was used to reconstruct the ocular surface.
RESULTS
Three of 7 eyes (42.9%) with tube erosion were successfully repaired by the first surgical treatment. No recurrence of tube erosion was found after the second and the fourth surgical procedure in 3 and 1 eyes, respectively. There was no case of explantation of the Ahmed valve in our series. Tube erosion recurred in 1 of the 4 eyes in which tube-repositioning was required and in 3 of the 5 eyes in which a partial thickness scleral flap was made to cover a tube. One eye experienced recurrent tube erosion in a relatively short-term interval and was repaired successfully using both collagen matrix implantation and amniotic membrane transplantation.
CONCLUSIONS
Tube erosion after Ahmed valve implantation was successfully treated by various methods including tube repositioning, partial thickness scleral flap combined with scleral allograft, biodegradable collagen implant, pericardial graft, and/or amniotic membrane transplantation.

Keyword

Ahmed valve; Surgical treatment; Tube erosion

MeSH Terms

Allografts
Amnion
Autografts
Collagen
Conjunctiva
Humans
Longitudinal Studies
Pericardium
Recurrence
Retrospective Studies
Transplants
Collagen

Figure

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  Figure 1. Surgical repair of tube erosion in patients with Ahmed valve implantation. (A) Repair of tube exposure using bovine pericardial graft in case 3. Implanted pericardium and overlying conjunctiva are well maintained at 4 months after the reconstruction. (B) Preoperative and postoperative findings using scleral allograft for tube exposure in case 6. (B-1) Exposed tube and scleral fixation suture are noted at 196 months after Ahmed valve implantation. (B-2) Exposed tube is repaired using scleral allograft and partial thickness scleral flap combined with amniotic membrane transplantation. Exposed suture knot is covered with scleral allograft and the conjunctiva. There is no exposure noted at 9 months after the reconstruction. (C) Combined methods to repair recurrent conjunctival erosions and exposure of scleral allograft using collagen matrix implantation and amniotic membrane transplantation in case 7. (C-1) Intraoperative findings during the 3rd amniotic membrane transplantation. Amniotic membrane is covered with epithelial side down over implanted scleral allograft and amniotic membrane inlay graft. (C-2) The scleral allograft is exposed again at 1 month after the 3rd amniotic membrane transplantation. (C-3) The conjunctiva over the previously exposed site is well maintained at 7 months after the 4th amniotic membrane transplantation combined with collagen matrix implantation.

Reference

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