Glaucoma Tube Shunt Revision with Scleral “Turtle-Plast”

Background: This article contains two cases with accompanying surgical videos, illustrating the use of a Tutoplast plug to create a watertight seal in the corneoscleral fistula formed after tube shunt removal. Case description: These cases demonstrate that Tutoplast can be cut into a strategic geometric shape to both plug the fistula formed at the tube entry site and reinforce adjacent areas of scleral thinning during tube removal or repositioning surgery. Specifically, a piece of dehydrated scleral Tutoplast was shaped into a small rectangle with an attached larger rectangle. The smaller rectangle or ”head” would plug the fistula, while the attached larger rectangle or ”body” could be used to reinforce the adjacent area of scleral thinning. The patch graft was sutured to the sclera at the four corners and resembled a turtle with four sutures for legs, with its head in the fistula. Hence, this technique is called the scleral ”Turtle-Plast.” Conclusion and clinical significance: This ”Turtle-Plast” technique is advantageous over direct suturing of the tube track because the head of the turtle provides an astigmatically neutral, watertight seal for the short anterior fistula, which can often be technically challenging to secure. Meanwhile, the body of the turtle can serve as a more substantive piece of patch graft to suture down to the underlying sclera that may be susceptible to thinning.