Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

Seung Woo Kim; Yong Hyun Kim; Il Suk Yun; Jae Hong Ahn

doi:10.3341/jkos.2016.57.3.453

Journal List > J Korean Ophthalmol Soc > v.57(3) > 1010533

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Kim, Kim, Yun, and Ahn: Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

Original Article

J Korean Ophthalmol Soc 2016;57(3):453-460.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.453

Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

Seung Woo Kim, MD, Yong Hyun Kim, MD, Il Suk Yun, MD, Jae Hong Ahn, MD, PhD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Jae Hong Ahn, MD, PhD, Department of Ophthalmology, Ajou University Hospital, #164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea, Tel: 82-31-219-5255, Fax: 82-31-219-5259, E-mail: chrisahn@ajou.ac.kr

Received 17 July 2015 Revised 29 December 2015 Accepted 9 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Ahmed valve, Surgical treatment, Tube erosion

References

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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.

Table 1.

Characteristics of the patients with tube erosion

Age (years)	58.4 ± 10.4
Sex (male/female)	2/5
Diagnosis (No. of cases)
NVG	4
CACG	1
ICE syndrome	1
Secondary glaucoma	1
Exposure time after surgery (months)	60.5 ± 67.5
Follow up after the first reconstruction (months)	31.8 ± 37.4
Ocular surgery history (No. of cases)
Trabeculectomy	2
Cataract operation	5
PKP	2
Ahmed valve implantation and removal	1
Reoperation (No. of cases)	4

Values are presented as mean ± SD unless otherwise indicated. NVG = neovascular glaucoma; CACG = chronic angle closure glaucoma; ICE = iridocorneal endothelial syndrome; PKP = penetrating keratoplasty.

Table 2.

Clinical features of the patients who underwent surgical treatment for tube erosion

Case No.	Sex/age (years)	Diagnosis	Intraocular operation history	Exposure time after surgery (months)	Method for the first repair			Additional procedure for re-exposure^*r	Follow up after the first reconstruction (months)
Case No.	Sex/age (years)	Diagnosis	Intraocular operation history	Exposure time after surgery (months)	Tube reposit ioning	Partial thickness scleral flap	Materials for ocular surface repair	Additional procedure for re-exposure^*r	Follow up after the first reconstruction (months)
1	F/61	NVG	None	80	Done	(-)	Advancement flap AM overlay	N/A	33
2	F/58	NVG	Cataract	38	(-)	(-)	Rotational flap	Tube repositioning, partial thickness scleral flap, scleral allograft, conjunctival autograft	113
3	F/38	ICE syndrome	DMEK,PKP, cataract	78	(-)	Done	Advancement flap	Tube repositioning, bovine pericardium, advancement flap	35
4	M/68	NVG	Trabeculectomy	26	(-)	Done	Rotational flap	N/A	8
5	F/64	CACG	Cataract, trabeculectomy	4	Done	Done	Advancement flap, AM overlay	Scleral allograft, AM inlay + overlay	12
6	F/53	Secondary glaucoma	PKP, cataract	196	(-)	Done	AM inlay + overlay	N/A	9
7	M/67^†	NVG	Cataract, removal of implanted Ahmed valve	2	(-)	Done	AM inlay + overlay	Collagen matrix implant, AM inlay + overlay	13

F = female; M = male; NVG = neovascular glaucoma; AM = amniotic membrane; N/A = not applicable; ICE = iridocorneal endothelial syndrome; DMEK = descemet membrane endothelial keratoplasty; PKP = penetrating keratoplasty; CACG = chronic angle closure glaucoma.

^* The scleral allografts were used for repairing tube erosion in all cases;

^† A case of conjunctival erosion without tube exposure.

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