Donor scleral graft vs pericardial graft vs scleral flap in tube drainage covering: advantages and disadvantages

Introduction
Glaucoma drainage devices (GDD) have become very popular in the surgical management of patients with glaucoma.

Areas covered
One of the important steps in GDD surgery is the tube coverage, in order to avoid the occurrence of postoperative tube exposure which carries the risk of infectious endophthalmitis. Several patch graft materials or autologous scleral procedures have been proposed, of which the donor scleral graft, pericardial graft, and scleral flap are among the most frequently adopted. We aimed to provide a comprehensive review of the literature on this topic, with a focus on the material and characteristics, surgical technique, and advantages and disadvantages of each of these three common options.

Expert opinion
Both donor scleral grafts and scleral flaps provide a low and similar rate of postoperative tube exposure and low costs. The scleral flap procedure is readily available but may carry the risk of intraoperative complications and corneal issues related to scleral biomechanical changes. Pericardial grafts are associated with higher rates of graft thinning and tube exposure.