GLAUCOMA 54 EWAP MARCH 2022 Atube shunt erosion or exposure is a complication that can occur oftentimes many years after surgery. Several experts discussed what to look for, why this complication occurs, and how to address it. Jonathan Myers, MD, noted there is about a 5–8% risk of a tube shunt erosion requiring a repair in the long run.1 It’s not rare, he said, but it’s infrequent enough to be overlooked, especially since it’s often many years after surgery. The most concerning cases are the ones where infection ensued, and what’s been most interesting is the vast majority of erosions don’t involve infection, he said. “It’s relatively uncommon to have a tube shunt-related infection,” Dr. Myers said. “But usually when you do, there’s an erosion.” Most patients are asymptomatic or may have a Tube shunt erosion/exposure by Ellen Stodola Editorial Co-Director # 6WDe eZposWre with eZWdates inside and aroWnd the intraocWNar portion oH the tWDe. $ 6WDe fiNNed with eZWdates and ceNNs. % %WttinI the tWDe. & 6he tWDe eZtender inserted into the proZiOaN end oH the tWDe. ' 6WDe inserted at oocNocM and corneaN patch IraHt on the tWDe. ( %onLWnctiXaN adXanceOent oXer the peripheraN cornea as the conLWnctiXa tend to retract it wiNN De at the NiODWs a Hew Oonths aHter sWrIery. Source: Reza Razeghinejad, MD Contact information Myers: JMyers@willseye.org Razeghinejad: razeghinejad@yahoo.com Smith: tsmith@glaucomaassociates.com This article originally appeared in the December 2021 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. little irritation under the eyelid. Sometimes an erosion is small (half a millimeter), while other times it has clearly been eroding for months and is larger (3–5 mm or even more), Dr. Myers said. Dr. Myers noted that there are a couple of risk factors for tube shunt erosion. Patients with a Boston KPro (Massachusetts Eye and Ear) seem more at risk. “They have surface issues, are on chronic steroids, and often wear contact lenses,” he said. “I do think it’s more common to have an erosion in that setting.” He noted a study by researchers at Duke University,2 who published a series on tube shunts, indicating that patients with multiple antiVEGF injections for macular degeneration and related issues were more likely to experience tube shunt erosions. According to Oluwatosin Smith, MD, tube exposure is one of the more common complications that can occur following tube shunt surgery. In the Tube Versus Trabeculectomy study, tube erosion occurred in 5% of patients in the tube shunt group with some of the patients having a recurrence.3 “It can occur early on, which may be related to surgical technique, or further along after the patient has had the tube for many years,” she said. The tube exposure can occur along the tube itself or along the plate of the drainage implant. Dr. Smith said some factors associated with tube erosion include location of the tube, positioning, the point of entry into the eye, and a patient’s history of other ocular surgeries or systemic disease. She also mentioned cases where the tube was exposed after trauma following a retina injection close to the tube. The possibility of exposure should be kept in mind when implanting a tube. It’s important to make sure the tube itself is covered by the eyelid at
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