# Successful Repair of Glaucoma Drainage Device Tube Exposure With a Corneal Patch Graft and Double-Layer Amniotic Membrane: A Case Report

## TL;DR

A patient with a glaucoma drainage device tube exposure was successfully treated with a corneal patch graft and double-layer amniotic membrane, preventing further complications.

## Contribution

A successful surgical approach combining corneal patch graft and double-layer amniotic membrane for persistent tube exposure is reported.

## Key findings

- Tube exposure was reduced and fully covered six months after surgical repair.
- The method provided durable coverage and promoted re-epithelialisation.
- Persistent exposure cases can be effectively managed with this combined surgical technique.

## Abstract

Tube exposure is a recognised complication of glaucoma drainage devices (GDD). We report a case of successful repair of GDD tube exposure using a corneal patch graft and double-layer amniotic membrane in a visually precious eye with previous multiple surgeries. A 47-year-old man with juvenile open-angle glaucoma (JOAG) underwent trabeculectomy in both eyes (OU) and two GDD implantations in the right eye (OD). The left eye (OS) trabeculectomy failed, leading to panophthalmitis and evisceration. Six years after the second GDD in the OD, the superonasal tube became exposed (3.8 mm). Initial repair with an amniotic membrane transplant (AMT) failed, leaving the tube partially exposed (3.2 mm) with scarred, stiff conjunctiva but no leakage. Visual acuity (VA) was counting fingers, and intraocular pressure (IOP) was 11 mmHg. Conservative management included autologous serum eye drops, topical antibiotics, oral doxycycline, and a bandage contact lens. After six months, exposure was reduced to 1.0 mm but increased to 2.0 mm by month eight. The patient underwent surgical repair with a corneal patch graft and double-layer AMT. At six months postoperatively, the tube remained fully covered with no conjunctival erosion. Tube exposure is sight-threatening and may lead to endophthalmitis; persistent or recurrent cases can be effectively managed with corneal patch grafting combined with double-layer AMT, providing durable coverage, promoting re-epithelialisation, and allowing assessment of the underlying device.