Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report

Background We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. Case presentation A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. Conclusion Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

Erosion of conjunctiva over the suture knot with a leak in an eye with a non-flow restrictive aqueous drainage device

We report a case of conjunctival erosion due to ligature suture knot exposure following Aurolab aqueous drainage device (AADI) implantation. A 48-year-old man, a known case of primary angle-closure glaucoma, had failed trabeculectomy with mitomycin-C and Ahmed glaucoma valve (AGV) in the right eye. The right eye had a large posterior AGV bleb with hypertropia and limitation of extraocular movement on downward gaze and uncontrolled intraocular pressure (IOP). An inferonasal AADI was performed uneventfully. At the 1-month postoperative visit, a small conjunctival erosion was noted over the ligature (6-0 vicryl) suture knot. However, there was no leak. Two weeks later, there was hypotony and a leak was noted at the site of the absorbed ligature. Immediate surgical repair was performed by re-ligature of the AADI tube with 8-0 vicryl and the ligature knot was placed under the scleral patch graft and the conjunctival defect was sutured. Early intervention helped in successfully healing the conjunctival erosion, reversal of the hypotony and well-controlled IOP. Adequate covering of the entire subconjunctival tube including its ligated part by a patch graft may prevent this complication.