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Editors Selection IGR 21-4

Surgery: Tissue reinforcement in exposed GDD

Comment by Robert Feldman on:

22984 Corneal patch graft repair of exposed glaucoma drainage implants, Singh M; Chew PT; Tan D, Cornea, 2008; 27: 1171-1173

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Singh et al. (419) report the use of corneal tissue as a tissue reinforcement graft to cover exposed tube portions of GDDs. Of the eight eyes in this case series, seven were successfully repaired with no recurrence despite the fact that six of the eyes had previous surgical attempts at repair. This series was not comparative to other techniques so no conclusions regarding other surgical interventions or use of other materials can be made. The series does tell us that with careful surgical intervention an exposed tube portion of a GDD can be repaired successfully. The paper does not address the most important aspect of repair, namely removing the reason for initial extrusion. Without removing the reason, recurrence is likely to occur. The literature is not clear on causes but tube movement, and conjunctival drying over the tube/patch have been implicated. By refreshing the edges of the wound, recovering the tube so there is no tube movement, and no sharp and highly elevated locations that result in desiccation or constant abrasion with lid closure, recurrence can likely be prevented. The technique reported in this paper appears to address these issues although the authors stress discussing the material used for the tissue reinforcement graft, rather than the procedure in its entirety. 

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