# A Case of Distinctive Corneal Opacity Following Ciliary Sulcus Ahmed Tube Insertion in a Patient With Glaucoma Associated With Atopic Dermatitis

## TL;DR

A patient with glaucoma and atopic dermatitis developed corneal opacity after an Ahmed tube implant, possibly due to eye rubbing and intermittent tube-corneal contact.

## Contribution

This case highlights a novel clinical observation of corneal opacity following sulcus tube insertion in atopic glaucoma patients.

## Key findings

- A stellate corneal opacity developed at the tube tip location during atopic dermatitis exacerbation.
- Anterior-segment OCT showed a measurable distance between the tube and corneal endothelium.
- Intermittent tube-corneal contact during eye rubbing was hypothesized to contribute to the opacity.

## Abstract

Corneal and conjunctival inflammation associated with atopic dermatitis is classified as atopic keratoconjunctivitis, and eye rubbing related to ocular itching is known to cause various ocular complications. We report a case of a Japanese man in his 40s with open-angle glaucoma associated with atopic dermatitis who developed a characteristic corneal opacity after Ahmed Glaucoma Valve (AGV) implantation with ciliary sulcus tube insertion. Despite the absence of persistent anatomical tube-corneal touch on serial examinations, a stellate corneal opacity developed at a site precisely corresponding to the tube tip during a period of exacerbated atopic dermatitis accompanied by frequent eye rubbing. Anterior-segment optical coherence tomography (OCT) consistently demonstrated a measurable distance between the tube and the corneal endothelium. Intermittent tube-corneal contact induced by corneal deformation during eye rubbing was hypothesized to be a plausible contributing factor. This case provides a clinical lesson that corneal damage related to the tube may occur even after sulcus tube insertion in patients with atopic glaucoma, highlighting the importance of careful postoperative corneal monitoring and appropriate management of atopic dermatitis.