Management of implant plate exposure of silicone Ahmed glaucoma valve: a review of six cases

Objective: To describe the management options for exposed silicone Ahmed glaucoma valve (AGV) implant. Methods: This was carried out as a retrospective chart review at a tertiary care eye hospital in Southern India. Medical records of six subjects managed for AGV exposure from 2006 to 2013 were reviewed. Results: All six eyes had explantation of the AGV and 3 of them had reimplantation in a different quadrant at a later date and the other 3 eyes were managed medically. All eyes had well controlled IOP at the last follow-up. The possible predisposing factors for exposure were improper conjunctival coverage, higher number of pre shunt surgeries and diabetes mellitus. Reimplantation was a challenge with scarred conjunctiva and the techniques used were conjunctival advancement, conjunctival relaxing incisions and contralateral conjunctival autograft. None had re-exposure but one eye had conjunctival erosion close to the limbus and was managed with scleral patch graft and conjunctival advancement. Conclusions: Implant exposure is a serious vision threatening complication following glaucoma drainage device implantation. Explantation and timely repair can save these eyes from serious sequel. Reimplantation is a good option, however warrants close follow-up for complications like erosion or re-exposure.