Silicon Retinal Detachment Rails As A Novel Approach To Prevent Ahmed Valve Tube Exposure In Combined Surgery: New Prospectives

To propose a novel technique employs silicon retinal detachment rails to cover Ahmed valve tubes, aiming to prevent complications in glaucoma management. Glaucoma drainage devices are vital for complex cases when standard surgeries fail, comprising a plate and tube implanted into the anterior chamber. Adequate tube coverage is crucial to prevent conjunctival erosion, which can lead to exposure, infections, and endophthalmitis. Traditionally, various tissues like sclera and pericardium are used, but availability and rejection risks pose challenges.

Department of Ophthalmology, G. Moscati Hospital, Avellino, Italy

Three over-50s patients with refractory glaucoma, cataract and a loss of visual acuity (median BCVA 20/400) underwent Ahmed valve implantation and cataract surgery due to impossible standard filtration surgery. To mitigate the risk of tube exposure, silicon retinal detachment rails were employed as a protective cover for the Ahmed valve tube. The silicon rails were carefully tailored to fit the tube securely without impeding its functionality. The surgical procedures, including the attachment of the silicon rails, were meticulously documented.

After six months postoperative follow-up revealed successful tube coverage with the silicon retinal detachment rails. The patients exhibited no signs of conjunctival erosion, and the risk of tube exposure was effectively mitigated. Intraocular pressure remained within the target range without use of anti-glaucomatous medication, and there were no adverse effects related to the use of silicon retinal detachment rails. Visual acuity improved and was maintained in all three patients (median BCVA 20/200), and they reported no discomfort.

The application of silicon retinal detachment rails as a protective cover for Ahmed valve tubes presents a promising strategy to prevent tube exposure and its associated complications and to avoid difficulties in finding tissue donors or in case of rejection of tissues. This innovative approach offers a viable solution for patients with refractory glaucoma, demonstrating its effectiveness in maintaining tube integrity and reducing the risk of endophthalmitis. Combinated surgery is an aviable option on the table. Further studies are warranted to validate the long-term success and safety of this technique in a larger patient cohort.

Moreover, new tailored silicon patches may be created to prevent tube exposure.