Patch grafts of dehydrated cadaveric dura mater for tube-shunt glaucoma surgery

Human donor sclera is commonly used in glaucoma surgery with a tube-shunt (eg, Molteno, Baerveldt, Shocket, Krupin-Denver) to cover the external portion of the silicone tube and prevent its erosion through the overlying conjunctiva. Common problems with this technique include immune-mediated melting of the graft and the potential for infectious disease transmission by the grafted material. A case is presented of a patient in whom a low-grade iridocyclitis was associated with the gradual melting of a scleral patch graft; the scleral patch was then replaced with commercially available, dehydrated human dura mater. The practical and theoretical advantages of cadaveric human dura mater in tube-shunt glaucoma surgery are discussed.