A Case Series and Systematic Review: Results of Surgical Management of Glaucoma Drainage Device Tube Exposure

Objective: To present a case series of patients who underwent surgical repair for glaucoma drainage device (GDD) tube exposure and conduct a systematic review to analyze results of various surgical techniques. Materials and Methods: This study provides the details of GDD tube exposure repair at our hospital. Additionally, a systematic review was conducted using electronic databases including EMBASE, MEDLINE, and CENTRAL. Data extraction and analysis included demographic information, surgical techniques, results, and duration of follow-up. Results: We reported nine cases of GDD tube exposure repair, with additional 109 cases from 24 previous studies. One of our challenging cases encountered multiple tube revision failures by the patch graft technique; the exposure issue was sustainably resolved by a hinge scleral flap with buccal mucosal graft technique. Of the 118 cases, various surgical techniques were used, including patch grafts, hinge scleral flaps, primary conjunctival closure and rerouting. Among the cases, 61.6% were classified as difficult cases. The overall first, fifth and thirteenth-year survival ratewas 90.7%, 86.2% and 86.2%, respectively. Rerouting and scleral flap/tunnel techniques demonstrated the highest survival rate. No statistically significant differences in survival outcomes were observed among patch graft, scleral flap/tunnel and rerouting method (P = 0.129). The mean survival duration was 33.54 months. The duration of follow-up was 35.01 months. Conclusion: Surgical management of GDD tube exposure yields favorable outcomes. A hinge scleral flap with buccal mucosal grafts can be a good option to treat challenging cases. The findings can shape an algorithm to manage GDD tube exposure.