Interpolated conjunctival pedicle flaps for the treatment of exposed glaucoma drainage devices.

OBJECTIVE To describe an alternative method to repair exposed glaucoma drainage devices (GDDs) when conventional attempts have failed. METHODS Four eyes, from 3 patients, with severe ocular surface disease were included in the study. All eyes had previously received a Baerveldt GDD for uncontrollable intraocular pressure and postoperatively had exposed GDDs. The conjunctival defects were unrepairable with a scleral patch or pericardium, conjunctival advancement, or a conjunctival patch graft. Two eyes had chemical burns, one eye had extensive scarring from multiple surgical procedures, and one patient had rheumatoid arthritis. Each patient provided informed consent, and was given the option of removing the GDD and undergoing diode cyclophotocoagulation or attempting to save the GDD by a conjunctival pedicle flap. An interpolated conjunctival pedicle flap was taken from the cul-de-sac (fornix). The conjunctiva and Tenon capsule were incised radially to the tube, rotated from the fornix at a 90 degrees angle, and sutured to the remaining healthy conjunctiva to cover the exposed tube. RESULTS Postoperatively, all eyes had vascularized flaps that showed viable tissue. All eyes retained the GDDs, and the intraocular pressure has been under control during follow-up (7, 13, 25, and 27 months). CONCLUSION Interpolated conjunctival pedicle flaps seem to be a viable alternative to repairing exposed GDDs when other methods are impractical or impossible.