LAUSR

In contemporaneous management of secondary and/or refractory glaucoma, glaucoma drainage devices (GDD) have assumed a position of great importance. Though existing literature abounds in the debate between valved and non‐valved devices, there is less deliberation on the patch graft (PG) that covers the tube, which is an integral part of any GDD surgery. There are a multitude of diverse materials available that may be used as a PG that may influence the healing of the conjunctiva and thereby may pre‐dispose to tube erosion and/or plate exposure. However, there are several other factors that may 'contribute to this,' but the graft that patches the anterior end of the tube remains one of the most important. Patch graft materials include sclera (allograft as well as autologous), cornea, pericardium, fascia lata, etc., and in some countries commercially available Tutoplast is also procurable.[1] Each material has its own unique characteristics and limitations. Grafts carry the risk of virus transmission, host corneal dellen formation, graft melting, and the latter three types of material have a cost implication. Scleral patch graft (SPG) is relatively cost‐effective and available in relative abundance but this is not true for corneal patch graft (CPG). Furthermore, it is advisable that only those corneal tissues not suitable for optical penetrating keratoplasty or donor buttons obtained after pre‐cut for lamellar procedures are considered for patch graft of a GDD tube. This will ensure optimum utilization of scarcely available donor cornea and will also drive down costs. Some surgeons avoid the use of a PG altogether, either by creating a long tunnel[2] or by entering the anterior chamber (AC)/sulcus under a long scleral flap[3] or even by combining the tunnel and the flap.[4]