Citation Information :
Aggarwal S, Kremer C, Engelhard S, Johnson S. Comparison of Locally Sourced Pericardium and Other Conventional Patch Graft Materials in a Glaucoma Drainage Device Surgery. J Curr Glaucoma Pract 2021; 15 (1):14-18.
Purpose: Our study aimed to compare the outcomes and costs of various patch graft materials used in the setting of glaucoma drainage device (GDD) surgeries: conventional Tutoplast® pericardium (TP), locally-obtained Lifenet® pericardium (LP), and tissue-banked corneal (CP) and scleral (SP) patches.
Design: Retrospective observational study.
Subjects: One hundred and ninety-five eyes of 185 patients who underwent glaucoma device surgery with patch grafts were included.
Materials and methods: Patient records were reviewed for demographics and surgical data including age at the time of GDD surgery, race, sex, eye, history of diabetes or immunologic disease, glaucoma diagnosis, length of follow-up, pre- and postoperative intraocular pressure (IOP), type and location of GDD, patch type, and tube-related complications.
Main outcome measures: The primary outcome measures were rates of patch graft-related complications including conjunctival dehiscence with and without tube exposure. Secondary outcome measures were IOP control achieved and cost of patch graft materials.
Results: Mean follow-up for all eyes was 17.1 months. Overall, conjunctival dehiscence without tube exposure occurred in four eyes (2.1%); tube exposure was seen in six eyes (3.1%). The mean time to exposure was 3.3 months (range 1–8 months). The rate of tube exposure was 2.3% of eyes with TP grafts, 10.7% of eyes with CP grafts, 2.8% of eyes with SP grafts, and 0% of eyes with LP grafts. There was no significant difference in rates of tube exposure rates by graft material (p = 0.26). Multivariate logistic regression analysis with adjustment for patch type, age, sex, implant type, and location revealed no significant risk factors for tube exposure. Univariate logistic regression was then performed on the same risk factors as well as diabetes, prior and concurrent ocular surgery, and showed no significance.
Conclusion: Our preliminary, short-term results show that locally sourced patch graft material can be a cost-effective alternative to traditionally used patch grafts without an increase in tube exposure rates. To further determine the efficacy of the different patch graft materials, longer-term comparative prospective trials are needed. Longer prospective studies are needed to compare the long-term safety and rate of tube exposures in these locally obtained patch graft materials.
Rollett M, Moreau M. Le drainage au crin de la chambre anterieure contre l'hypertonie et la douleur. Rev Gen Ophtalmol 1907;26:289–292.
Molteno AC, Straughan JL, Ancker E. Long tube implants in the management of glaucoma. S Afr Med J 1976;50(27):1062–1066.
Coleman AL, Wilson MR, Tam M, et al. Initial clinical experience with the Ahmed glaucoma valve implant--correction. Am J Ophthalmol 1995;120(5):684. DOI: 10.1016/s0002-9394(14)72225-1.
Patel S, Pasquale LR. Glaucoma drainage devices: a review of the past, present, and future. Semin Ophthalmol 2010;25(5-6):265–270. DOI: 10.3109/08820538.2010.518840.
Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012;153(5):789–803.e2. DOI: 10.1016/j.ajo.2011.10.026.
Gedde SJ, Singh K, Schiffman JC, et al. The tube versus trabeculectomy study: interpretation of results and application to clinical practice. Curr Opin Ophthalmol 2012;23(2):118–126. DOI: 10.1097/ICU.0b013e32834ff2d1.
Tamcelik N, Ozkok A, Sarıcı AM, et al. Tenon advancement and duplication technique to prevent postoperative Ahmed valve tube exposure in patients with refractory glaucoma. Jpn J Ophthalmol 2013;57(4):359–364. DOI: 10.1007/s10384-013-0249-5.
Gedde SJ, Scott IU, Tabandeh H, et al. Late endophthalmitis associated with glaucoma drainage implants. Ophthalmology 2001;108(7): 1323–1327. DOI: 10.1016/s0161-6420(01)00598-x.
Lind JT, Shute TS, Sheybani A. Patch graft materials for glaucoma tube implants. Curr Opin Ophthalmol 2017;28(2):194–198. DOI: 10.1097/ICU.0000000000000347.
Minckler DS, Francis BA, Hodapp EA, et al. Aqueous shunts in glaucoma: a report by the American Academy of Ophthalmology. Ophthalmology 2008;115(6):1089–1098. DOI: 10.1016/j.ophtha.2008.03.031.
Riva I, Roberti G, Oddone F, et al. Ahmed glaucoma valve implant: surgical technique and complications. Clin Ophthalmol 2017;11:357–367. DOI: 10.2147/OPTH.S104220.
Al-Torbak AA, Al-Shahwan S, Al-Jadaan I, et al. Endophthalmitis associated with the Ahmed glaucoma valve implant. Br J Ophthalmol 2005;89(4):454–458. DOI: 10.1136/bjo.2004.049015.
Wentzloff JN, Grosskreutz CL, Pasquale LR, et al. Endophthalmitis after glaucoma drainage implant surgery. Int Ophthalmol Clin 2007;47(2):109–115. DOI: 10.1097/IIO.0b013e318037766a.
Byun YS, Lee NY, Park CK. Risk factors of implant exposure outside the conjunctiva after Ahmed glaucoma valve implantation. Jpn J Ophthalmol 2009;53(2):114–119. DOI: 10.1007/s10384-008-0630-y.
Chen H, Zhang SX, Liu L, et al. Intermediate-term and long-term clinical evaluation of the Ahmed glaucoma valve implantation. Zhonghua Yan Ke Za Zhi 2005;41(9):796–802.
Montañez FJ, Laso E, Suñer M, et al. Ahmed drainage device implant. Our experience between 1995 and 2003. Arch Soc Esp Oftalmol 2005;80(4):239–244. DOI: 10.4321/s0365-66912005000400007.
Siegner SW, Netland PA, Urban RC, et al. Clinical experience with the Baerveldt glaucoma drainage implant. Ophthalmology 1995;102(9):1298–1307. DOI: 10.1016/s0161-6420(95)30871-8.
Smith MF, Doyle JW, Ticrney JW. A comparison of glaucoma drainage implant tube coverage. J Glaucoma 2002;11(2):143–147. DOI: 10.1097/00061198-200204000-00010.
Wishart PK, Choudhary A, Wong D. Ahmed glaucoma valves in refractory glaucoma: a 7-year audit. Br J Ophthalmol 2010;94(9): 1174–1179. DOI: 10.1136/bjo.2009.165357.
Stewart WC, Kristoffersen CJ, Demos CM, et al. Incidence of conjunctival exposure following drainage device implantation in patients with glaucoma. Eur J Ophthalmol 2010;20(1):124–130. DOI: 10.1177/112067211002000117.
Netland P, Chaku M, Ishida K, et al. Risk factors for tube exposure as a late complication of glaucoma drainage implant surgery. Clin Ophthalmol 2016;10:547–553. DOI: 10.2147/OPTH.S104029.
Freedman J. Scleral patch grafts with molteno setons. Ophthalmic Surg 1987;18(7):532–534.
Thakur S, Ichhpujani P, Kumar S. Grafts in glaucoma surgery: a review of the literature. Asia Pac J Ophthalmol (Phila) 2017;6(5):469–476. DOI: 10.22608/APO.2016123.
Muir KW, Lim A, Stinnett S, et al. Risk factors for exposure of glaucoma drainage devices: a retrospective observational study. BMJ Open 2014;4(5):e004560. DOI: 10.1136/bmjopen-2013-004560.
Zalta AH. Long-term experience of patch graft failure after Ahmed glaucoma valve(R) surgery using donor dura and sclera allografts. Ophthalmic Surg Lasers Imaging 2012;43(5):408–415. DOI: 10.3928/15428877-20120517-01.
Trubnik V, Zangalli C, Moster MR, et al. Evaluation of risk factors for glaucoma drainage device-related erosions: a retrospective case-control study. J Glaucoma 2015;24(7):498–502. DOI: 10.1097/IJG.0000000000000034.
Levinson JD, Giangiacomo AL, Beck AD, et al. Glaucoma drainage devices: risk of exposure and infection. Am J Ophthalmol 2015;160(3):516–521.e2. DOI: 10.1016/j.ajo.2015.05.025.
Pakravan M, Yazdani S, Shahabi C, et al. Superior versus inferior Ahmed glaucoma valve implantation. Ophthalmology 2009;116(2):208–213. DOI: 10.1016/j.ophtha.2008.09.003.
Geffen N, Buys YM, Smith M, et al. Conjunctival complications related to Ahmed glaucoma valve insertion. J Glaucoma 2014;23(2):109–114. DOI: 10.1097/IJG.0b013e31826ab693.