Risk factors for exposure of glaucoma drainage devices: a retrospective observational study

Abstract

ObjectivesThe purpose of this study was to identify risk factors for exposure of glaucoma drainage devices (GDD).SettingThis retrospective, observational study was conducted in the eye clinic of an academic medical centre.ParticipantsParticipants included 1073 consecutive adults who underwent GDD surgery between 1 January 2005 and 1 January 2011. Participants were included if chart review indicated GDD surgery during the study period and excluded if at least 12 months of clinical follow-up was not available in the medical record.Primary outcome measureThe primary outcome measure was exposure of the GDD occurring at least 1 month after implant surgery. The characteristics of participants who experienced exposure of the implant were compared to the characteristics of participants who did not experience exposure.ResultsOf the 1073 participants having undergone GDD surgery, 67 experienced exposure of the device. Neither the type of GDD, type of patch graft (eye bank sclera, Tutoplast sclera and Tutoplast pericardium), surgeon, location of GDD, number of GDD previously implanted into the eye, nor history of diabetes or uveitis were associated with likelihood of exposure. Women were more likely than men to experience exposure of the GDD (OR 2.004 (95% CI1.170 to 3.431)) in both univariable (p=0.011) and multivariable (p=0.013) analyses. In survival analysis, exposure of the GDD occurred earlier for women than for men (58 vs 61 months; p=0.024).White race (vs black) was also associated with increased risk of GDD exposure (OR 1.693 (95% CI 1.011 to 2.833)) in univariable (p=0.044) and multivariable (p=0.046) analyses.ConclusionsWomen are two times more likely to experience GDD exposure than men, independent of age. White race is also a risk factor for exposure.

Heterologous, Fresh, Human Donor Sclera as Patch Graft Material in Glaucoma Drainage Device Surgery

“…Follow-up in our study is probably adequate, and is substantially longer compared with a previous report in the Chinese literature, 13 as the median and mean time to exposure has been determined between 8.3 to 14.4 months and 23 to 31 months in the previous studies. 10,21 In our cohort the single case of tube/plate exposure was discovered at the 1-month postoperative visit. A large meta-analysis determined a 2.0 ± 2.6% incidence of tube exposure after an average follow-up of 26.1 ± 3.3 months.…”

“…8 A number of causes for tube/plate erosion have been postulated including immunemediated inflammation causing patch graft melting, excessive tension or mechanical friction of tissue, poor perfusion, and ischemic damage to the conjunctiva. [9][10][11] Conjunctival erosion and GDD exposure requires immediate surgical repair, which is, however, challenging and may require multiple additional revisions after the initial repair and implant removal in a substantial proportion of cases. 12 The purpose of this pilot study was to determine the safety and efficacy of fresh, human donor cornea-sclera obtained immediately after keratoplasty, as patch graft material in GDD surgery.…”

Clinical outcomes of gamma-irradiated sterile cornea in aqueous drainage device surgery: a multicenter retrospective study

“…It has been reported that no material used for ADD tube coverage is more prone to erosion than another, including sclera, tutoplast sclera, dura, and tutoplast pericardium. 24,27 However, in a large comparative case series, Zalta 17 found that sclera eroded significantly faster than dura after ADD surgery, though the PGF rate suggested that dura and sclera tissues are equally successful in 94% of ADD surgeries. In the study by Wigton et al 9 the glycerol-preserved cornea group presented a significantly lower PGF rate (1.9%, mean follow-up of 14.5 months) compared with the pericardium group (8.9%, mean follow-up of 11.0 months).…”

A Successful Early Postoperative Shunt Plate Erosion Repair-Case Report

“…A mechanical contribution is also possible as reported in later shunt erosions [3,4]. Uveitis was reported to not significantly increase the chronic risk for shunt exposure [5]. However, early tube erosion in an inflamed eye was previously described [3].The patch graft was positioned bevel and parallel to the shunt ridge as well as covered the adjacent shunt tube to reduce mechanical forces upon the transposed conjunctiva.…”