Supplementary Material for: Partial-Thickness Corneal Patch Graft with Fibrin Glue for Tube Shunt Exposure - Case Report

Introduction: Tube exposure is a serious complication of glaucoma drainage device (GDI) implantation. We describe a novel surgical approach using a partial-thickness corneal patch graft with conjunctival autograft and fibrin glue in a setting of severe conjunctival deficiency. Case Presentation: We describe a 72-year-old man with chronic angle-closure glaucoma who presented with tube exposure one year after Ahmed valve implantation. Risk factors included diabetes mellitus, a failed trabeculectomy, and prior vitrectomy. The conjunctiva surrounding the exposed tube was ischemic and immobile, and the original corneal patch graft had partially degraded. Revision surgery involved suturing a 4 mm partial-thickness corneal button over the exposed tube, anchored to the residual graft edge and sclera. Due to insufficient mobile conjunctiva, a 4×3 mm conjunctival autograft was harvested from the temporal bulbar conjunctiva and secured with fibrin glue at the border of the corneal button, partially covering it, to promote epithelialization. At one-year follow-up, the tube remained fully covered with no recurrence. Conclusion: This unique surgical approach using a partial-thickness corneal button and conjunctival autograft offers a viable alternative in cases of tube exposure with severe conjunctival deficiency, where traditional techniques such as conjunctival advancement are not feasible.