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Glaucoma drainage devices (GDDs) have become a mainstay in the management of eyes with complicated glaucoma and corneal disease. Reported rates of successful intraocular pressure control have varied between 65% and 95%.1 2 3 4 5 The presence of a GDD in the anterior chamber (AC) has been associated with a higher incidence of corneal decompensation and corneal graft failure, usually as a result of tube–endothelium contact, and continuous rubbing of endothelium by the device. The estimated rate of corneal decompensation following GDD is 16%.6 There are several solutions to prevent the tube from contacting the corneal endothelium such as tube reposition or shortening of the tube, or pars plana tube insertion.
Descemet stripping and automated keratoplasty (DSAEK) is largely replacing penetrating keratoplasty as the treatment of choice for endothelial disease. DSAEK surgery in the setting of a GDD in the anterior chamber is challenging, and the presence of the tube may make disc positioning difficult.
We describe a new technique of preparing the corneal lenticule during DSAEK to avoid the area of the glaucoma tube in the anterior chamber when the tube is tightly apposed to the posterior cornea and cannot be repositioned.
A 23-year-old man presented to our clinic with left blurred vision. The patient had a history of bilateral idiopathic pars planitis, developed secondary cataract and glaucoma and underwent Ahmed valve implantation in both eyes at the age of 13, followed by cataract surgeries in both eyes 2 years later. The preoperative best-corrected visual acuity (BCVA) was 20/70 in the right eye and counting fingers at 1 m in the left eye. The intraocular pressure was 10 mm Hg in the right eye and 12 mm Hg in the left eye.
On examination, he had diffuse corneal oedema with contact of the Ahmed tube with …