Migration of glaucoma drainage device extender into anterior chamber after trauma

Glaucoma drainage devices, on rare occasions, need repositioned and the intraocular portion of the implant tube is found to be "too short" to do so. Previously, a technique was described for "extending" the tube with angiocatheter material (rather than replacing the entire apparatus), and had been performed successfully without complication for 7 years. This case describes the first known complication: trauma causing anterior chamber migration of the tube extension requiring retrieval and reconstruction of the tube extension apparatus.

One eye of 1 patient (age 8) with a prior glaucoma drainage device and tube extension with angiocatheter material with elevated intraocular pressure after direct trauma to the eye from a pencil. Office examination revealed inferior corneal edema and no tube segment visible in the anterior chamber on limited examination due to age-related compliance. Gonioscopy under anesthesia revealed the tube extender in the inferior anterior chamber. The tube extender was retrieved from the anterior chamber. The glaucoma drainage device was surgically exposed and the tube extension was reconstructed, including securing the tube extension with a suture placed through the lumens of both the angiocatheter extender and the tube extension.

The reconstructed tube extension maintained good draining function with the secured extension and no further migration of the tube extension into the anterior chamber was seen.

Tube extension using angiocatheter material continues to be a viable, cost-effective option in difficult cases. Placing a securing suture in patients prone to eye trauma can be considered.