Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report
Abstract Background The surgical management of patients with uncontrolled glaucoma and scleroderma is challenging, as the hostile ocular surface poses a challenge to surgery. A serious complication is tube erosion, with the risk of subsequent endophthalmitis. Here, we present a novel technique of ha...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Ophthalmology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12886-018-0856-5 |
| _version_ | 1818231919599419392 |
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| author | Gurjeet Jutley Elizabeth Yang Phillip Bloom |
| author_facet | Gurjeet Jutley Elizabeth Yang Phillip Bloom |
| author_sort | Gurjeet Jutley |
| collection | DOAJ |
| description | Abstract Background The surgical management of patients with uncontrolled glaucoma and scleroderma is challenging, as the hostile ocular surface poses a challenge to surgery. A serious complication is tube erosion, with the risk of subsequent endophthalmitis. Here, we present a novel technique of harvesting autologous tissue to successfully manage recurrent tube extrusion. Case presentation MG is a 60-year-old Arabic lady diagnosed with scleroderma, that was previously managed with systemic corticosteroids. She has chronic open angle glaucoma, with a failed left eye trabeculectomy, which was then managed by a Baerveldt tube (BVT) insertion. Eight months after this primary surgery, she developed an anterior uveitis. This was further complicated by conjunctival erosion, tube exposure, leak around the sclerostomy site and hypotony. The erosion was likely secondary to her tight eyelids as a result of her scleroderma. She was taken back to theatre for tube revision, with single layer amniotic membrane transplant (AMT) over the exposed area, but the tube was eroding again after 2 months. She eventually underwent tube extraction, pars plana tube plate stabilisation, pars plana vitrectomy (PPV), pars plana tube insertion, phacoemulsification and intra-ocular lens insertion, jointly with the vitreo-retinal surgeons and with high dose prednisolone cover both pre- and post-operatively. We harvested the capsule which had grown over the end plate of the original tube. We sutured this over the new tube, specifically over a single layer of tutoplast prior to conjunctival closure. Almost a year on, the pars plana tube remains in place with no complications. Conclusions This case highlights the role of a pars plana tube in cases of cicatricial disease, with the use autologous tissue instead of grafts wherever possible. In patients with systemic disease such as scleroderma, pre-operative immunosuppression helps to reduce the of erosion in difficult cases. |
| first_indexed | 2024-12-12T10:58:02Z |
| format | Article |
| id | doaj.art-39965d1682c840379820bc4d513d3c30 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-12-12T10:58:02Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-39965d1682c840379820bc4d513d3c302022-12-22T00:26:36ZengBMCBMC Ophthalmology1471-24152018-09-0118S11610.1186/s12886-018-0856-5Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case reportGurjeet Jutley0Elizabeth Yang1Phillip Bloom2Western Eye HospitalWestern Eye HospitalWestern Eye HospitalAbstract Background The surgical management of patients with uncontrolled glaucoma and scleroderma is challenging, as the hostile ocular surface poses a challenge to surgery. A serious complication is tube erosion, with the risk of subsequent endophthalmitis. Here, we present a novel technique of harvesting autologous tissue to successfully manage recurrent tube extrusion. Case presentation MG is a 60-year-old Arabic lady diagnosed with scleroderma, that was previously managed with systemic corticosteroids. She has chronic open angle glaucoma, with a failed left eye trabeculectomy, which was then managed by a Baerveldt tube (BVT) insertion. Eight months after this primary surgery, she developed an anterior uveitis. This was further complicated by conjunctival erosion, tube exposure, leak around the sclerostomy site and hypotony. The erosion was likely secondary to her tight eyelids as a result of her scleroderma. She was taken back to theatre for tube revision, with single layer amniotic membrane transplant (AMT) over the exposed area, but the tube was eroding again after 2 months. She eventually underwent tube extraction, pars plana tube plate stabilisation, pars plana vitrectomy (PPV), pars plana tube insertion, phacoemulsification and intra-ocular lens insertion, jointly with the vitreo-retinal surgeons and with high dose prednisolone cover both pre- and post-operatively. We harvested the capsule which had grown over the end plate of the original tube. We sutured this over the new tube, specifically over a single layer of tutoplast prior to conjunctival closure. Almost a year on, the pars plana tube remains in place with no complications. Conclusions This case highlights the role of a pars plana tube in cases of cicatricial disease, with the use autologous tissue instead of grafts wherever possible. In patients with systemic disease such as scleroderma, pre-operative immunosuppression helps to reduce the of erosion in difficult cases.http://link.springer.com/article/10.1186/s12886-018-0856-5Pars plana tubeBaerveldt tubeTube erosionSclerodermaSystemic sclerosisGlaucoma drainage surgery |
| spellingShingle | Gurjeet Jutley Elizabeth Yang Phillip Bloom Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report BMC Ophthalmology Pars plana tube Baerveldt tube Tube erosion Scleroderma Systemic sclerosis Glaucoma drainage surgery |
| title | Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report |
| title_full | Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report |
| title_fullStr | Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report |
| title_full_unstemmed | Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report |
| title_short | Surgical management of raised intra-ocular tension in the hostile ocular surface - recurrent tube erosion in a patient with systemic sclerosis: a case report |
| title_sort | surgical management of raised intra ocular tension in the hostile ocular surface recurrent tube erosion in a patient with systemic sclerosis a case report |
| topic | Pars plana tube Baerveldt tube Tube erosion Scleroderma Systemic sclerosis Glaucoma drainage surgery |
| url | http://link.springer.com/article/10.1186/s12886-018-0856-5 |
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