EPITHELIAL INGROWTH AND GLAUCOMA DRAINAGE IMPLANTS

Background: The authors report four cases of conjunctival epithelial i nvasion into the fibrous capsule surrounding a Baerveldt glaucoma impl ant. All cases were associated with concurrent or recent prior scleral buckling surgery. Methods: Three patients had postoperative conjuncti val wound leaks, one in the immediate postoperative period and the oth er two at 9 and 17 days postoperatively after release of the tube liga ture. In the fourth patient, a fistulous tract developed over the impl ant after a first-stage insertion. Histopathologic confirmation of sub conjunctival epithelialization was obtained in two of these patients. Results: Surgical revision was performed in all patients. Excision and debridement of all epithelium-lined subconjunctival tissues and exten sive bipolar cautery were used in the three patients with wound leaks. Implant removal also was performed in one of these. Fistulectomy and bipolar cautery were used in the fourth patient. No recurrent wound le aks or other adverse sequelae were noted. Conclusions: Epithelial inva sion of the subconjunctival space and inner bleb wall after implantati on of glaucoma drainage devices can lead to breakdown of the conjuncti val wound and persistent aqueous leak. Prior or concurrent scleral buc kling surgery may predispose to this occurrence. Surgical revision inv olving epithelial debridement, cautery, and meticulous wound closure, with or without implant removal, has been used successfully in the man agement of this complication.