Glaucoma drainage device erosion rescued with upper eyelid forniceal conjunctival pedicle flap

To report a case of Ahmed glaucoma drainage device tube erosion due to suspected mitomycin C-induced ischemia of surrounding conjunctival tissue and its successful management using a forniceal pedicle flap.

A 71-year-old female with a history of prior failed trabeculectomy with mitomycin C (MMC) presented with tube erosion one month postoperatively following Ahmed glaucoma drainage device (GDD) implantation. The patient underwent primary repair with an amniotic membrane graft. Due to rapid, extensive, recurrent erosion seven weeks later, MMCtissue toxicity was suspected as the etiology of tube exposure. A forniceal conjunctival pedicle flap reconstruction was utilized to reestablish vascularity and successfully prevented recurrent erosion.

Tube erosion due to MMC-induced ischemia may cause recurrent degradation of the surrounding conjunctival tissue, posing an infectious risk. Reconstruction with a forniceal pedicle flap is a powerful technique to repair GDD erosions in the setting of large tissue defects and/or poor vascularity.