Exposed Glaucoma Drainage Device

A patient with a history of moderate primary open angle glaucoma, pseudophakia, and diabetic macular edema of the right eye presented for a regularly scheduled glaucoma follow-up examination. He had previously undergone a trabeculectomy and subsequent revision in the right eye, and he had also received Baerveldt glaucoma drainage implant in this eye. He regularly received intravitreal dexamethasone implants for diabetic macular edema. He was monocular due to a history of Gunderson flap in the left eye due to refractory bullous keratopathy despite multiple endothelial transplants and after a failed trabeculectomy and two glaucoma drainage device implants. He had no acute visual complaints, and Humphrey visual field testing was stable. Visual acuity was 20/40, and his intraocular pressure was 7. Slit lamp examination was notable for an 2 mm exposure of his inferonasal glaucoma drainage device. There was no purulent drainage over the device, nor was there anterior chamber or vitreous cell to indicate infection of the device. He underwent revision of the glaucoma drainage device with dissection of adjacent conjunctiva for mobilization, followed by covering the exposed site with a scleral patch graft. The site was able to be successfully closed, and he remained stable on his current glaucoma drop regimen of travoprost and dorzolamide-timolol.

Presentation Date: 09/09/2021

Issue Date: 09/24/2021