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Ahn and Park: Tube Erosion with Scleral Melting after Ahmed Valve Implantation Using a Synthetic Dural Substitute
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(7): 879-884.

Published online: 14 July 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.879

Tube Erosion with Scleral Melting after Ahmed Valve Implantation Using a Synthetic Dural Substitute

Hyun Min Ahn, MD1, 2, Jong Woon Park, MD, PhD2

1Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Address reprint requests to Jong Woon Park, MD, PhD. Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea. Tel: 82-31-900-0590, Fax: 82-31-900-0049, unij413@naver.com

Received 9 February 2017       Revised 17 April 2017       Accepted 23 June 2017

©2017 The Korean Ophthalmological Society

(open-access):

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

The objective of this case report was to present tube erosion of Ahmed valve implantation using a synthetic dura substitute (Neuro-Patch®, B. Braun, Boulogne, France).

Case summary

Tube erosion was caused by dissolution of the conjunctiva and partial-thickness scleral tunnel in 5 patients who received Ahmed valve implantation using a synthetic dura substitute for glaucoma treatment 2 to 4 months after the operation. Furthermore, the patients required re-operation for preventing secondary complications such as endophthalmitis.

Conclusions

This case series using a synthetic dura substitute in Ahmed valve implantation demonstrated the risk of tube erosion with scleral tunnel melting and following secondary complications even with a partial-thickness scleral tunnel method.

Keywords: Ahmed valve complication, Neuro-patch, Synthetic dura, Tube erosion

Figures and Tables

Figure 1

Image of Neuro-patch® (B. Braun, Boulogne, France). 3 × 3 mm Neuro-patchy was placed on scleral flap and covered with conjunctival flap.

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Figure 2

Images of tube erosions with scleral melting in Ahmed valve implantation using a synthetic dura substitute (case 4). (A) One month after the operation, synthetic dura substitute was shown through the thinning conjunctival in the left eye. (B) The conjunctival thinning was aggravated for 2 weeks. (C) 3 months after the operation, Ahmed valve tube was exposed with melting sclera and conjunctiva and synthetic dura substitute was difficult to be recognized from the original shape. (D) Ahmed valve revision was performed with collagen glycoaminoglycan substitute.

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Figure 3

Four months after Ahmed valve implantation using a synthetic dura substitute in case 3. (A) Ahmed valve tube was exposed with conjunctival buttonhole in the left eye. (B) Ahmed valve body was exposed through the conjunctival buttonhole in right eye.

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Table 1

The history of the patients with Ahmed valve implantation using a synthetic dura substitute

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R = right; L = left; M = male; F = male; DM = diabetic mellitus; PDR = proliferative diabetic retinopathy; NVG = neovascular glaucoma; POAG = primary open-angle glaucoma; CRF = chronic renal failure; CAOD = coronary artery occlusive disease; OP = operation; HBV = hepatitis B-viral; IOL = intraocular lens.

Table 2

The treatment and complications of the patients with Ahmed valve implantation using a synthetic dura substitute

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IOP = intraocular pressure calculated with Goldmann applanation tonometer (mmHg).

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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