Alsirhy E, Alromaih A, Almutairi F, Altoub H. Giant papillary conjunctivitis after Ahmed glaucoma valve implantation with double-layer pericardial patch graft tube coverage: A case report. World J Clin Cases 2026; 14(24): 122570 [DOI: 10.12998/wjcc.122570]
Corresponding Author of This Article
Azam Alromaih, MD, Department of Ophthalmology, King Saud University, Riyadh 11411, Saudi Arabia. okazam3@gmail.com
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Ophthalmology
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case-report
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Alsirhy E, Alromaih A, Almutairi F, Altoub H. Giant papillary conjunctivitis after Ahmed glaucoma valve implantation with double-layer pericardial patch graft tube coverage: A case report. World J Clin Cases 2026; 14(24): 122570 [DOI: 10.12998/wjcc.122570]
World J Clin Cases. Aug 26, 2026; 14(24): 122570 Published online Aug 26, 2026. doi: 10.12998/wjcc.122570
Giant papillary conjunctivitis after Ahmed glaucoma valve implantation with double-layer pericardial patch graft tube coverage: A case report
Ehab Alsirhy, Azam Alromaih, Faris Almutairi, Haifa Altoub
Ehab Alsirhy, Azam Alromaih, Faris Almutairi, Haifa Altoub, Department of Ophthalmology, King Saud University, Riyadh 11411, Saudi Arabia
Haifa Altoub, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh 12392, Saudi Arabia
Co-first authors: Ehab Alsirhy and Azam Alromaih.
Author contributions: Alsirhy E managed the patient and conceptualized the report; Alromaih A drafted the manuscript; Alsirhy E, Alromaih A, Almutairi F, and Altoub H collected and interpreted the clinical data, revised the manuscript critically for important intellectual content, and approved the final version of the manuscript; Alsirhy E and Alromaih A have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were manually reviewed and revised by the authors.
Informed consent statement: Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Azam Alromaih, MD, Department of Ophthalmology, King Saud University, Riyadh 11411, Saudi Arabia. okazam3@gmail.com
Received: April 22, 2026 Revised: June 23, 2026 Accepted: July 15, 2026 Published online: August 26, 2026 Processing time: 119 Days and 21.8 Hours
Abstract
BACKGROUND
Giant papillary conjunctivitis (GPC) is an inflammatory disorder of the superior tarsal conjunctiva characterized by enlarged papillae, hyperemia, itching, foreign-body sensation, and mucous discharge. It is most commonly associated with contact lens wear, but may also occur in non-contact-lens wear because of chronic mechanical irritation, such as exposed sutures, ocular prostheses, scleral buckles, and elevated filtering blebs after glaucoma surgery. In postoperative patients, GPC may mimic infection or glaucoma drainage device-related complications, which can delay diagnosis and lead to unnecessary concern regarding tube exposure or device failure. Recognition of this entity is clinically important because prompt diagnosis may allow effective medical treatment and preservation of the implant.
CASE SUMMARY
A 57-year-old man with advanced primary angle-closure glaucoma underwent Ahmed glaucoma valve implantation in the left eye after failed trabeculectomy and inadequate intraocular pressure control. The tube was covered with double-layer processed human pericardial patch graft. Five months after surgery, he developed progressive itching, redness, foreign-body sensation, and mucous discharge from the operated eye. Upper eyelid eversion revealed marked superior tarsal conjunctival hyperemia with multiple giant papillae. The cornea was clear, the anterior chamber was deep and quiet, and the tube and patch graft were intact and well positioned, without exposure. No exposed sutures, retained foreign body, tube exposure, or graft exposure was identified; therefore, the exact trigger could not be confirmed. A possible explanation is that the tube-patch complex created a higher conjunctival profile, thereby increasing friction between the superior tarsal conjunctiva and the graft area during blinking, which may have provoked a papillary response. He was treated with topical fluorometholone 0.1% and olopatadine 0.1% twice daily. Symptoms improved within two weeks. At the final follow-up, 1 month after treatment, there was complete resolution without recurrence, best-corrected visual acuity had improved to 20/40, and intraocular pressure remained stable.
CONCLUSION
GPC may occur after Ahmed glaucoma valve implantation even when the tube and double-layer pericardial patch graft remain fully covered and unexposed. In postoperative patients presenting with itching, redness, or mucous discharge, routine upper eyelid eversion is essential for establishing the diagnosis and preventing misdiagnosis. Early recognition and prompt medical treatment may relieve symptoms and preserve implant function.
Core Tip: Giant papillary conjunctivitis may develop after Ahmed glaucoma valve implantation even when the tube and pericardial patch graft remain fully covered and unexposed. In this patient, postoperative itching, redness, and mucous discharge were caused by superior tarsal giant papillae rather than infection or device failure. Routine upper lid eversion is essential in symptomatic patients, because early recognition allows successful medical treatment and preservation of implant function.
