Tacrolimus eye drops treatment for recurrent exposure of the Ahmed glaucoma valve tube.

PURPOSE

To investigate the effectiveness and safety of 0.1% tacrolimus eye drops in treating recurrent exposure after initial repair of Ahmed glaucoma valve tubes.

MATERIALS AND METHODS

After reviewing all patients who underwent AGV implantation at a single center from January 2016 to March 2022, 11 patients (11 eyes) were enrolled in this retrospective study and divided into two treatment groups: a study group and a control group. All GDDs were initially implanted with AGV and were followed up for at least 1 year. All patients experienced drainage tube exposure after the first operation and subsequently underwent secondary surgical treatment. When postoperative observations revealed that the conjunctiva began to dissolve at the edge of the drainage tube, patients in the study group (n = 5) received topical 0.1% tacrolimus eye drops twice daily, while patients in the control group (n = 6) received tobramycin 0.3%/dexamethasone 0.1% eye drops four times daily. The mean treatment duration for both groups was 1.64 ± 0.67 months (range: 1-3 months). The subjective eye symptoms and objective eye signs were evaluated by the same ophthalmologist.

RESULTS

In the study group, conjunctival dissolution recurred in 5 patients (5 eyes) at an average of 14 ± 11 days (range: 7-33 days) after the initial repair. Four eyes underwent allogeneic scleral patch grafting, whereas one eye was repaired with an autologous scleral tunnel. In the control group, conjunctival dissolution recurred in 6 patients (6 eyes) at an average of 15 ± 9 days (range: 7-29 days) after the initial repair. Four eyes were treated with allogeneic scleral patch transplantation, while two eyes were repaired using autologous conjunctival transplants. The primary clinical manifestations in both groups were bulbar conjunctival perforations and erosion. Notably, all patients in the study group achieved complete healing within an average of 17 ± 2.0 days (range: 15-20 days) after treatment with 0.1% tacrolimus eye drops, with no adverse reactions observed during follow-up evaluations. In contrast, in the control group, conjunctival erosion persisted despite treatment with tobramycin 0.3%/dexamethasone 0.1% eye drops for an average duration of 1.83 ± 0.75 months (range: 1-3 months), leading to prolonged drainage tube exposure.

CONCLUSIONS

Treatment with 0.1% tacrolimus eye drops demonstrated satisfactory results in managing recurrent exposure following allogeneic scleral patch graft coverage and autologous scleral tunnel repair, suggesting its potential as an effective alternative to conventional treatments.