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Editors Selection IGR 20-3
Surgical Treatment: Drainage devices
Comment by Robert Feldman on:
52003 Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve, Choudhari NS; Neog A; Sharma A et al., Indian Journal of Ophthalmology, 2013; 61: 23-27
Chaudhari et al. report a small case series of using tissue glue to anchor scleral patch grafts in Ahmed glaucoma Valve placement. They look at postoperative patch position as an outcome measure. The glue had no apparent effect on efficacy of the anterior chamber tube shunt. There was an 8% rate of clearly visible graft dislocation and an 8% rate of conjunctival retraction. Since the conjunctiva was closed with suture it is unlikely related to use of glue unless the glue made closure more difficult. Additionally many cases of anterior chamber tube shunts are placed in eyes with significant conjunctival scarring making conjunctival retraction a real possibility postoperatively. In these cases, a small pocket can be created to insert the tube which is just large enough to fit a patch over the tube.
Sutures [..] should remain the routine standard of care
Suture or glue may not be required because the patch has nowhere to migrate. Despite a technique opening the conjunctiva five-mm posterior to the limbus patch migration occurred. Since sutures are easy and quick to place and at low cost with few complications they should remain the routine standard of care but gluing the patch with tissue glue instead is a viable option. This study reports a higher than expected rate of dislocation but a single case results in the high rate.
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