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Conjunctival autograft and amniotic membrane in the management of postoperative conjuctival wound leaks following Baerveldt drainage device surgery

Poster Details

First Author: M.Zoric Geber CROATIA

Co Author(s):    V. Lacmanovic Loncar   Z. Vatavuk                 

Abstract Details

Purpose:

To report a surgical tecnique using conjuctival autograft and amniotic membrane to repair epithelial ingrowth with conjuctival wound leak after Baerveldt drainage device surgery.

Setting:

Ophthalmology Clinic, Clinical Hospital Center Sestre milosrdnice

Methods:

A consecutive series of six cases that underwent drainage tube shunt surgery with Baerveldt drainage implant for refractory glaucoma. The first patient developed conujctival wound leak first week postoperatively and underwent successfully conjuctival resuturing. The sixth patient developed persisting conjuctival wound leak with hypotony maculopathy after multiple unsuccessful resuturing procedures. Excision and debridement of epithelium subconjunctival tissues and cautery were performed. The tube was ligated with 7/0 Vicryl suture and covered with dehidrated sclera patch. Conjuctival defect was repaired with conjuctival autograft from inferior fornix to avoid tension. The whole area was covered with amniotic membrane.

Results:

Successful conjuctival closure was achived with no signs of leaks. Intraocular pressure (IOP) was medically controled two week postoperatively. Four weeks after surgery IOP was 10 with no medications. Optical coherente tomography showed reduction of the macular folds.

Conclusions:

Epithelial invasion of the subconjunctival space after implantation of glaucoma drainage devices can lead to conjunctival defect and persistent aqueous leak. Surgical revision involving epithelial debridement, cautery, tube ligation and wound closure with conjuctival autograft and amniotic membrane can be used successfully in the management of this rare complication.

Financial Disclosure:

NONE

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