|
 |
| CASE REPORT |
|
| Year : 2015 | Volume
: 22
| Issue : 1 | Page : 115-116 |
|
|
Fibrin sealant-assisted revision of the exposed Ahmed tube
Nikhil S Choudhari1, Aditya Neog2, Supriya Latka2, Bhaskar Srinivasan3
1 Department of Glaucoma, Jadhavbhai Nathamal Singhvi, Sankara Nethralaya, Chennai, Tamil Nadu; V S T Glaucoma Centre, Dr. Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
2 Department of Glaucoma, Jadhavbhai Nathamal Singhvi, Sankara Nethralaya, Chennai, Tamil Nadu, India
3 Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, Chennai, Tamil Nadu, India
| Date of Web Publication | 1-Jan-2015 |
Correspondence Address:
Bhaskar Srinivasan
Medical Research Foundation, Sankara Nethralaya, 18/41, College Road, Chennai - 600 006, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-9233.148360
 Abstract | | |
Tube exposure is a known complication of Ahmed glaucoma valve (AGV) implantation. Repair of the exposed tube is not easy. A 42-year-old monocular aphakic male had undergone retinal detachment repair with placement of an episcleral-encircling band followed by implantation of AGV. He presented to the clinic on routine review with exposure of the shunt tube. The complication was managed by placing scleral and conjunctival grafts over the exposed tube using a fibrin adhesive (Tisseel kit; Baxter AG, Vienna, Austria). The novel use of the fibrin sealant in the repair of AGV tube exposure was for better graft-integration. Keywords: Ahmed Glaucoma Valve, Episcleral Encircling Element, Fibrin Sealant, Tube Exposure
How to cite this article:
Choudhari NS, Neog A, Latka S, Srinivasan B. Fibrin sealant-assisted revision of the exposed Ahmed tube. Middle East Afr J Ophthalmol 2015;22:115-6 |
How to cite this URL:
Choudhari NS, Neog A, Latka S, Srinivasan B. Fibrin sealant-assisted revision of the exposed Ahmed tube. Middle East Afr J Ophthalmol [serial online] 2015 [cited 2022 Jan 28];22:115-6. Available from: http://www.meajo.org/text.asp?2015/22/1/115/148360 |
| Introduction | |  |
Glaucoma drainage implants (GDI) are a useful modality in the management of intractable glaucoma cases. Late exposure of the implant tube through the overlying conjunctiva is a known complication of the surgical procedure. Untreated tube exposure seems to be a risk factor for endophthalmitis. [1] Gedde et al. recommended prophylactic surgical revision with patch graft in all cases of tube exposure. [1] We describe the novel use of fibrin sealant for the surgical revision of tube exposure.
| Case Report | | |
A 42-year-old male had retinal detachment repair with placement of an episcleral encircling band in right eye. His left eye had no light perception. An Ahmed glaucoma valve (AGV; model FP7, New World Medical, Rancho Cucamonga, LA) was placed to treat his intractable secondary open-angle glaucoma. The plate of the AGV was placed above the encircling band in the supero-temporal quadrant and the donor scleral patch graft covering the limbal portion of the tube was sutured with non-absorbable sutures to the underlying sclera. Eight months after implantation of AGV, he presented with tube exposure. [Figure 1]a. The visual acuity was 20/80. The IOP was 16 mmHg. The scleral patch graft overlying the AGV tube had retracted posteriorly by about 3 mm. | Figure 1: (a) Slit-lamp photograph at 8-month post-Ahmed valve implantation. The arrow indicates the exposed tube segment. The dashed line outlines the scleral patch graft, (b) Schematic demonstrating layering of scleral and conjunctival grafts during revision surgery. The arrow heads denote sticking of lateral edges of the conjunctival auto-graft to the edges of the reflected conjunctiva and the underlying episcleral surface, (c) Slit-lamp photograph at 4-month post-revision surgery shows well-integrated patch grafts
Click here to view |
We performed revision surgery of the exposed tube under peribulbar anesthesia. The conjunctiva was incised in a parallel fashion on either side of the exposed tube. A lateral flap of the conjunctiva was undermined in the episcleral plane on either side of the exposed tube. A 5 × 3-mm human donor scleral patch graft was stuck on the episcleral bed over the exposed segment of the tube using fibrin sealant (Tisseel kit; Baxter AG, Vienna, Austria). Adequate care was taken to avoid capture of the conjunctiva under the scleral patch graft to reduce the chances of epithelial entrapment and epithelial inclusion cyst formation. [2] A 7 × 4-mm-free conjunctival autograft was obtained from the inferior fornix and was stuck over the scleral patch graft. The lateral edges of the conjunctival graft were stuck to the edges of the conjunctival flap as well as to the episcleral surface beyond the scleral graft using the fibrin sealant [Figure 1]b. Amniotic membrane was fixed with the fibrin sealant to cover the denuded conjunctival surface in the inferior fornix. The grafts were well integrated and IOP was in the target range at the 4-month post-revision follow-up visit [Figure 1]c.{Figure 1}
| Discussion | | |
Tube exposure occurs in patients with drainage devices despite the use of patch grafts that are covered with the patient's conjunctiva. An inflammatory and/or immune mediated melting of the patch graft and mechanical breakdown of the overlying conjunctiva appears to be a prominent mechanism. [3] In our case, the scleral patch graft, though intact, was retracted posteriorly. Conjunctival scarring and retraction following AGV implantation above the pre-existing episcleral encircling element may be responsible for retraction of the scleral patch graft, and thereby, might have predisposed to exposure of the tube.
The surgical repair of exposed tube involves replacing a patch and covering this patch by conjunctiva. A graft of collagenous human tissue is necessary as conjunctiva does not reliably remain closed over immediately underlying synthetic material e.g. silicone as in this case. [2] In a study comparing donor sclera, pericardium, and dura as materials for GDI tube coverage, no material was found to be associated with a reduced rate of tube exposure. [4] We chose human donor sclera as it is readily available and most affordable. Some methods to cover the patch by conjunctiva include conjunctival advancement, [3] vascularized flap [5] or grafting. Our patient had limited mobility of the superior conjunctiva and either conjunctival advancement, or vascularized conjunctival flap was not possible. However, we could use a free conjunctival autograft. Buccal mucous membrane graft [6] and amniotic membrane transplantation [7] have been described as conjunctival substitutes to cover exposed GDI tubes. Nevertheless, the best repair method for tube exposure is yet to be determined.
Suturing of the patch graft ensures only point contact at the suture sites. Moreover, the suture material may act as a source of inflammation and localized tissue melt. This was reported to be the cause of failure of repaired tube exposure. [7] On the other hand, fibrin sealant has been shown to be safe and effective suture substitute for conjunctival and scleral wound closure in glaucoma surgery [8] and for placement of a human donor scleral patch graft covering the sub-conjunctival portion of AGV tube. [9],[10] In addition to saving suturing time, the fibrin sealant did allow sticking of the conjunctival graft to the edges of the conjunctiva on either side as well as to the underlying episcleral surface beyond the extent of the revision scleral patch graft in our case. Since our patient was relatively young and had a thick tenon's capsule, the adhesion was expected to be strong. The intention of this surgical modification was to gain maximum possible blood supply to the grafted conjunctiva. In our opinion, this novel use of the fibrin sealant and the technique used help in better integration of the patch grafts in the revision of an often difficult problem of exposed AGV tube.
| References | | |
| 1. | Gedde SJ, Scott IU, Tabandeh H, Luu KK, Budenz DL, Greenfield DS, et al. Late endophthalmitis associated with glaucoma drainage implants. Ophthalmology 2001;108:1323-7.  |
| 2. | Kalenak JW. Revision for exposed anterior segment tubes. J Glaucoma 2010;19:5-10. |
| 3. | Heuer DK, Budenz DL, Coleman A. Aqueous shunt tube erosion. J Glaucoma 2001;10:493-6. |
| 4. | Smith MF, Doyle JW, Ticrney JW. A comparison of glaucoma drainage implant tube coverage. J Glaucoma 2002;11:143-7. |
| 5. | Godfrey DG, Merritt JH, Fellman RL, Starita RJ. Interpolated conjunctival pedicle flaps for the treatment of exposed glaucoma drainage devices. Arch Ophthalmol 2003;121:1772-5. |
| 6. | Low SA, Rootman DB, Rootman DS, Trope GE. Repair of eroded glaucoma drainage devices: Mid-term outcomes. J Glaucoma 2012;21:619-22. |
| 7. | Ainsworth G, Rotchford A, Dua HS, King AJ. A novel use of amniotic membrane in the management of tube exposure following glaucoma tube shunt surgery. Br J Ophthalmol 2006;90:417-9. |
| 8. | Bahar I, Weinberger D, Lusky M, Avisar R, Robinson A, Gaton D. Fibrin glue as a suture substitute: Histological evaluation of trabeculectomy in rabbit eyes. Curr Eye Res 2006;31:31-6. |
| 9. | Zeppa L, Romano MR, Capasso L, Tortori A, Majorana MA, Costagliola C. Sutureless human sclera donor patch graft for Ahmed glaucoma valve. Eur J Ophthalmol 2010;20:546-51. |
| 10. | Choudhari NS, Neog A, Sharma A, Iyer GK, Srinivasan B. Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve. Indian J Ophthalmol 2013;61:23-7. [ PUBMED]  |
[Figure 1]
| This article has been cited by | | 1 |
Tissue adhesives: From research to clinical translation |
|
| Ayça Bal-Ozturk, Berivan Cecen, Meltem Avci-Adali, Seda Nur Topkaya, Emine Alarcin, Gokcen Yasayan, Yi-Chen Ethan Li, Bunyamin Bulkurcuoglu, Ali Akpek, Huseyin Avci, Kun Shi, Su Ryon Shin, Shabir Hassan | | Nano Today. 2021; 36: 101049 | | [Pubmed] | [DOI] | | | 2 |
Improving Glaucoma Surgical Outcomes with Adjunct Tools |
|
| Louise J Lu, Laura Hall, Ji Liu | | Journal of Current Glaucoma Practice. 2018; 12(1): 19 | | [Pubmed] | [DOI] | | | 3 |
Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma |
|
| Richard Trevino, William E Sponsel, Carolyn E Majcher, Joey Allen, Jeffery Rabin | | Journal of Current Glaucoma Practice. 2018; 12(1): 29 | | [Pubmed] | [DOI] | | | 4 |
Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber |
|
| Keith Barton, Laura Beltran-Agullo, Jason Cheng, Kin Sheng Lim, Anurag Garg, Kirithika Muthusamy | | Journal of Current Glaucoma Practice. 2018; 12(1): 36 | | [Pubmed] | [DOI] | | | 5 |
Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude |
|
| Shibal Bhartiya, Oscar Albis-Donado, Giovanna Casale-Vargas, Marina Gil-Reyes, Nancy Arreguin-Rebollar, Malik Y Kahook | | Journal of Current Glaucoma Practice. 2018; 12(1): 40 | | [Pubmed] | [DOI] | | | 6 |
Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma |
|
| Ian AS Rodrigues, Pouya Alaghband, Saurabh Goyal | | Journal of Current Glaucoma Practice. 2018; 12(1): 45 | | [Pubmed] | [DOI] | | | 7 |
Micropulse P3™ (MP3) Laser for Glaucoma: An Innovative Therapy |
|
| Maria Cecilia Aquino, Dawn Lim, Paul TK Chew | | Journal of Current Glaucoma Practice. 2018; 12(2): 51 | | [Pubmed] | [DOI] | | | 8 |
Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program |
|
| Loka Thangamathesvaran, Elliot Crane, Kunjal Modi, Albert S Khouri | | Journal of Current Glaucoma Practice. 2018; 12(2): 53 | | [Pubmed] | [DOI] | | | 9 |
Potential Savings from Visit Reduction of Continuous Intraocular Pressure Monitoring |
|
| Jiaxi Dong, Zeba A Syed, Kenneth Fan, Ali F Yahya, Samir A Melki | | Journal of Current Glaucoma Practice. 2018; 12(2): 59 | | [Pubmed] | [DOI] | | | 10 |
Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management: A Comparative Laboratory Study |
|
| Karl J Mercieca, Cecilia H Fenerty, Laura R Steeples, Brett Drury, Archana Bhargava | | Journal of Current Glaucoma Practice. 2018; 12(2): 64 | | [Pubmed] | [DOI] | | | 11 |
Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis |
|
| Marko Popovic, Xavier Campos-Möller, Hady Saheb, Iqbal Ike K Ahmed | | Journal of Current Glaucoma Practice. 2018; 12(2): 67 | | [Pubmed] | [DOI] | | | 12 |
Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study |
|
| Ahmed Elbably, Tageldin M Othman, Ahmed Mousa, Mohammed Elridy, Wesam Badawy, Mohammed Elbably | | Journal of Current Glaucoma Practice. 2018; 12(2): 85 | | [Pubmed] | [DOI] | | | 13 |
Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet\'s Stripping Automated Endothelial Keratoplasty |
|
| Sunil Shah, Mrinal Rana, Pravin Pandey, Imran Masood | | Journal of Current Glaucoma Practice. 2018; 12(2): 90 | | [Pubmed] | [DOI] | | | 14 |
Bilateral Phacomatosis Pigmentovascularis in a Young Male with Developmental Glaucoma and Varicose Veins |
|
| Kirti Singh, Ankush Mutreja, Mainak Bhattacharyya, Sonal Dangda, Kirti Jaisingh | | Journal of Current Glaucoma Practice. 2018; 12(2): 94 | | [Pubmed] | [DOI] | | | 15 |
Comparative Evaluation of Antibacterial Efficacy of 5% Sodium Hypochlorite, 940 nm Diode Laser, and Gaseous Ozone against Enterococcus faecalis Biofilm formed on Tooth Substrate: A Scanning Electron Microscope Study |
|
| Disha Mehta, Pallav Choksi, Rupal Vaidya, Kunjal Mistry, Zarna Sanghvi, Pruthvi Patel | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 1 | | [Pubmed] | [DOI] | | | 16 |
Effect of Post Space Irrigation using Novel Irrigant: SmearOFF (containing Chlorhexidine and EDTA) on the Push-out Bond Strength of Fiber Posts luted with Self-adhesive Resin Cement |
|
| Vibha Hegde, Amrita V Sali | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 7 | | [Pubmed] | [DOI] | | | 17 |
Influence of Dentin Desensitizers on the Bond Strength of Self-etch Adhesive to Dentin: An in vitro Study |
|
| Sneha Jeetendra, Anithakumari Rangappa, Meena Naganathan, Vijayalakshmi Lakshminarasimhaiah | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 18 | | [Pubmed] | [DOI] | | | 18 |
Caries Risk Assessment: A Critical Look |
|
| Carounanidy Usha | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 22 | | [Pubmed] | [DOI] | | | 19 |
Endodontic Management of Mandibular Premolars with Three Roots and Three Canals |
|
| Allu Baby, T Prasanth Dhanapal, Shabeer Ummer TK, Helma George | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 28 | | [Pubmed] | [DOI] | | | 20 |
Smile Design using Recurring Esthetic Dental Proportion |
|
| S Vidhya Shankari, R Vinoo Subramaniam, K Karpagavinayagam | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 33 | | [Pubmed] | [DOI] | | | 21 |
Management of Internal Resorption with Perforation |
|
| Shekar Shobana, K Girija | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 38 | | [Pubmed] | [DOI] | | | 22 |
Management of the Open Apex using New Biomaterials |
|
| Ashwini Prasad, Jaya Purewal | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 43 | | [Pubmed] | [DOI] | | | 23 |
Management of Cracked Teeth: A Report of Two Cases |
|
| Arunajatesan Subbiya, Nagarajan Geethapriya, Suresh Mitthra, Paramasivam Vivekanandhan | | Journal of Operative Dentistry & Endodontics. 2018; 3(1): 48 | | [Pubmed] | [DOI] | | | 24 |
Evaluating the Oral Health Knowledge and the Status of Visually Impaired Children using Braille |
|
| Sapna S Kudtarkar | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 41 | | [Pubmed] | [DOI] | | | 25 |
Geriatric Nutrition in Denture Wearers: Revisited |
|
| Meenakshi S Iyer, Sanjana Madarapu, KN Raghavendra Swamy | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 47 | | [Pubmed] | [DOI] | | | 26 |
Prevalence of Medical Conditions among Dental Patients at a Community-based Dental Clinic, Trinidad: A Preliminary Investigation |
|
| Avind Harracksingh, Ramaa Balkaran, Nicoli Rajcoomar, Keiron Jackson, Sarah Deosaran, Nadeline Gaffoor, Diana Haripersaud, Racquel Lutchmedial, Amy Maharaj, Amit Ramharacksingh, Vanesha Sewalia | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 51 | | [Pubmed] | [DOI] | | | 27 |
Evaluation of Greater Palatine Foramen and Incisive Canal Foramen among Saudi Patients using Cone Beam Computed Tomography Scans |
|
| Muath K Alotaibi, Mohammad A Alansari, Jarallah M Alqahtani, Abdullah A Alduhaymi, Ahmad Assari, Mohammad A Baseer | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 56 | | [Pubmed] | [DOI] | | | 28 |
Occupational Hazards in Oral Healthcare Professionals |
|
| Minal M Kshirsagar, Harshal Bafna, Jagdishchandra Vathar, Kapil R Sonawane, Sandhya Naik, Suryakant Powar | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 62 | | [Pubmed] | [DOI] | | | 29 |
Presurgical Nasoalveolar Molding in a Neonate with Unilateral Cleft Lip and Palate |
|
| Arun Kumar, Saumil Mogre | | Journal of Oral Health and Community Dentistry. 2018; 12(2): 67 | | [Pubmed] | [DOI] | | | 30 |
Clinical Efficacy of Classical Ayurvedic Formulations Vatari Guggulu, Rasnasaptaka Kashaya, and Brihat Saindhavadya Taila in the Management of Rheumatoid Arthritis (Amavata): An Open-label Prospective Randomized Multicenter Study |
|
| Varanasi Subhose, Bharti LNU, Shashi Ghosh, Rakesh K Rana, Avinash K Jain, Vinod B Kumavat, Maheswar Thugutla | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 1 | | [Pubmed] | [DOI] | | | 31 |
Evaluation of Vyoshadi Guggulu and Haritaki Churna in the Management of Dyslipidemia: A Multicenter Prospective Clinical Study |
|
| Paravazhi Radhakrishanan, Varanasi Subose, Guru C Bhuyan | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 12 | | [Pubmed] | [DOI] | | | 32 |
Integration of AYUSH (Ayurveda and Yoga) with National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS): An Appraisal of Central Council for Research in Ayurvedic Sciences Research and Development Initi |
|
| Bharti LNU, Sandhya Rani, Arun Bhadula, Vinod K Shahi | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 27 | | [Pubmed] | [DOI] | | | 33 |
An Analytical Review of Acharya Charaka\'s Perspective of Diet in Pramehi W.S.R. to Honey, Semidigested Foods, and Aged Grains |
|
| Konica Gera, Nellufar Siddique, Baldev K Dhiman | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 37 | | [Pubmed] | [DOI] | | | 34 |
Garbha Samskar: Ayurveda Way of Epigenetic Programming |
|
| Raman Kaushik, Shital Chinchalkar | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 42 | | [Pubmed] | [DOI] | | | 35 |
Abhighataja Katigraha: A Case Study |
|
| Divya Gupta, Arun Gupta, Anup Jain, Vishakha Wetal | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 50 | | [Pubmed] | [DOI] | | | 36 |
Idiopathic Isolated (Right) Complete Oculomotor Nerve Palsy Management with Ayurvedic Treatment |
|
| Riju Agarwal, Manju Rani, Kamini Dhiman | | Journal of Research in Ayurvedic Sciences. 2018; 2(1): 55 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
