Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Abstract

PurposeTo compare the use of human donor sclera with bovine pericardium as patch graft material for a glaucoma drainage device (GDD), with respect to the incidence of tube exposure, and to study the role of a drainage suture.MethodsAll GDD surgeries between 2010 and 2014 performed at the VU Medical Center were examined in this comparative, retrospective cohort study. A total of 244 cases were included; 163 in the human donor sclera cohort and 81 in the bovine pericardium cohort with a median follow‐up of 31 and 36 months, respectively. The primary outcome measure was occurrence of tube exposure. Survival analysis for tube exposure was carried out and Kaplan–Meier curves compared. Secondary outcomes were postoperative intraocular pressure (IOP), number of glaucoma medications and the effect of a drainage suture.ResultsIn the bovine pericardium cohort, eleven (13.6%) eyes developed tube exposure compared to none in the human donor sclera cohort. Their Kaplan–Meier survival curves differed significantly from each other (χ² = 21.1, p < 0.001, log‐rank test). Mean IOP and number of glaucoma medications did not differ significantly between patch graft materials at three months of follow‐up. The use of a drainage suture directly lowered IOP after surgery in both cohorts. Within the bovine pericardium cohort, eyes with a drainage suture experienced more tube exposure, although this difference was not statistically significant (p = 0.09).ConclusionHuman donor sclera leads to less tube exposure than bovine pericardium. A drainage suture directly lowers IOP after surgery. With bovine pericardium, but not with donor sclera, exposure tends to be enhanced by a drainage suture.

Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

“…; van Hoefen Wijsard et al. ). Antibiotic drops were given for two weeks (chloramphenicol 0.4% three times a day); steroids for 10 weeks (dexamethasone 0.1% three times a day for eight weeks followed by two times a day for two weeks).…”

“…Intraocular pressure (IOP)-lowering drugs were continued unchanged until tube opening (typically six weeks after the intervention) and then tapered depending on the IOP. As of 2009, some patients got a drainage suture for early IOP reduction (Rietveld et al 2009;van Hoefen Wijsard et al 2018). Antibiotic drops were given for two weeks (chloramphenicol 0.4% three times a day); steroids for 10 weeks (dexamethasone 0.1% three times a day for eight weeks followed by two times a day for two weeks).…”

The surgical management of glaucoma: A review

“…Prevention of early hypotony in non-valved tubes is with a tube ligature suture (usually 5-8/0 Vicryl or 10/0 nylon) or an intraluminal stent suture (Supramid or nylon) or a combination of the two. Early postoperative IOP control techniques include slits to the tube, orphan trabeculectomies (unaugmented trabeculectomies that are expected to fail after a few weeks), wick sutures [107][108][109] and a combined XEN-GDD technique. 110 The anterior portion of the tube has been covered variously with partial thickness scleral flap, donor sclera, donor cornea, pericardium, dura and autologous fascia lata.…”

Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma

“…Exposure of the tube or plate and the erosion of the conjunctiva following LTSS is reported in 2–7% of the adult cases [ 2 , 3 , 7 , 9 , 11 ]—serving as a nidus for infection and a risk factor for endophthalmitis. To prevent these complications, patch grafts, including human donor sclerae [ 1 , 7 , 12 , 13 , 14 , 15 ], fasciae latae [ 16 ], dura mater [ 17 ], pericardia [ 15 , 18 ], corneas [ 19 ], autologous semithick scleral flaps [ 5 , 7 , 8 , 9 , 20 , 21 ], and autologous scleral tunnels [ 20 , 21 , 22 , 23 , 24 ], are usually used to cover the external portion of the tube. However, owing to the fragile structure of the frequently inflamed and surrounding scar tissue near the tube, placing the patch on top of the tube and closing the conjunctiva above this patch requires expertise and skill, especially when using a donor patch graft.…”