# Limbal reconstruction in uveitic glaucoma patient with exposed Ahmed valve coincident with corneal melting and iris prolapse using multiple corneoscleral allografts

## TL;DR

This paper describes a complex surgical case involving limbal reconstruction and allograft use to treat a uveitic glaucoma patient with corneal melting and iris prolapse.

## Contribution

The paper presents a novel surgical approach using multiple corneoscleral allografts for limbal reconstruction in a rare and complex ophthalmic case.

## Key findings

- Multiple corneoscleral allografts successfully restored anatomy and normalized IOP in a patient with Ahmed valve exposure.
- Surgical improvisation and prolonged time were necessary for effective repair of corneal melting and iris prolapse.
- The approach involved specific graft orientation and suturing techniques to reconstruct the limbal area.

## Abstract

Aim: To present a complex case of Ahmed tube exposure 6 months after the implantation associated with corneal melting and iris prolapse, and the surgical reposition that required multiple allografts and limbal reconstruction.

Methods: A 60-year-old patient arrived at the emergency room with tube exposure combined with corneal melting and iris prolapse from a previously placed Ahmed valve 6 months prior. Our approach was to use one corneoscleral graft to repair the melted cornea and avoid further iris prolapse and a second scleral graft to cover the repositioned tube. Upon completion of conjunctival dissection, cleaning and deepithelization of the melted cornea and the tube by application of alcohol 100% followed. A new entry point was made for the tube and was covered using an alcohol-preserved scleral allograft and the previous entry point was repaired using a corneoscleral allograft with the corneal aspect restoring the limbus and avoiding further iris protrusion.

Results: 6 months follow-up of the patient showed excellent recovery, anatomical restoration, and IOP normalization.

Conclusion: Surgical repair of these cases can be very demanding, and requires surgical improvisation and prolonged surgical time. The literature remains very limited on how a surgeon should approach similar cases, which are the crucial tips, and which are the missteps that should be avoided. In this case, we used multiple scleral/corneoscleral allografts in a specific orientation and different sutures to reconstruct the damaged limbal area and restore the anatomy.

Abbreviations: VA = Visual Acuity, GDD = Glaucoma Drainage Device, IOP = Intra Ocular Pressure