Partial-Thickness Corneal Patch Graft with Fibrin Glue for Tube Shunt Exposure: Case Report

Tube exposure is a serious complication of glaucoma drainage device implantation. We describe a novel surgical approach using a partial-thickness corneal patch graft with conjunctival autograft and fibrin glue in a setting of severe conjunctival deficiency.

We describe a 72-year-old man with chronic angle-closure glaucoma who presented with tube exposure 1 year after Ahmed valve implantation. Risk factors included diabetes mellitus, a failed trabeculectomy, and prior vitrectomy. The conjunctiva surrounding the exposed tube was ischemic and immobile, and the original corneal patch graft had partially degraded. Revision surgery involved suturing a 4-mm partial-thickness corneal button over the exposed tube, anchored to the residual graft edge and sclera. Due to insufficient mobile conjunctiva, a 4 × 3 mm conjunctival autograft was harvested from the temporal bulbar conjunctiva and secured with fibrin glue at the border of the corneal button, partially covering it, to promote epithelialization. At 1-year follow-up, the tube remained fully covered with no recurrence.

This unique surgical approach using a partial-thickness corneal button and conjunctival autograft offers a viable alternative in cases of tube exposure with severe conjunctival deficiency, where traditional techniques such as conjunctival advancement are not feasible.