Risk Factors for Earlier Reexposure of Glaucoma Drainage Devices

Manjunath, Varsha; Muir, Kelly W.

doi:10.1097/ijg.0000000000000821

Cited by 7 publications

(16 citation statements)

References 23 publications

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“…Glaucoma drainage device (GDD) surgeries have become a mainstay for glaucoma treatment [1, 2] but carry the risk of implant exposure, a serious complication that can result in postoperative endophthalmitis [3–5]. To prevent this, a variety of materials have been used as grafts to cover and prevent exposure of drainage tubes, including sclera [6], fresh cornea [7, 8], glycerin-preserved cornea [9], pericardium [10], fascia lata [11], dura mater [12], porcine intestinal submucosa [13], and amniotic membrane [14].…”

Section: Introductionmentioning

confidence: 99%

Electron Beam Irradiated Corneal Versus Gamma-Irradiated Scleral Patch Graft Erosion Rates in Glaucoma Drainage Device Surgery

et al. 2019

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Introduction Patch graft erosion and implant exposure is a known complication of glaucoma drainage device (GDD) surgery. Recently, electron beam (e-beam) irradiated corneal tissue ha s become available; however, limited data exist on the rates of erosion for e-beam irradiated corneal grafts compared to traditional scleral grafts after GDD surgery. Methods This retrospective study examines the records of 253 eyes from 225 adult subjects who underwent GDD surgery with either e-beam irradiated corneal or scleral grafts at the Casey Eye Institute by five surgeons between April 22, 2014 and October 11, 2017. Surgical procedures and the occurrence of graft erosion were determined using billing codes and verified by manual review of electronic health records. Results The average age at the time of surgery was 61.3 ± 17.5 years ( n = 200) and 60.8 ± 16.8 years ( n = 53) for the e-beam irradiated cornea and sclera groups, respectively. The average follow-up time post-surgery was 416 ± 345 days and 495 ± 343 days for the e-beam irradiated cornea and sclera groups, respectively. There were no statistically significant differences in sex, age, follow-up time, and glaucoma diagnosis between the groups; however, the e-beam irradiated cornea group was statistically more likely to have an Ahmed implant as compared to the sclera group. No erosion events were noted in either group. Conclusion e-Beam irradiated corneal grafts were used 3.8 times more frequently relative to scleral grafts, yet there were no cases of graft erosion in either group during the follow-up period.

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Section: Introductionmentioning

confidence: 99%

Electron Beam Irradiated Corneal Versus Gamma-Irradiated Scleral Patch Graft Erosion Rates in Glaucoma Drainage Device Surgery

et al. 2019

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“… 17 Thompson et al reported 44% re-exposure rate. 18 Singh et al reported a higher exposure rate of 75%. Six out of eight eyes which underwent one or more GDD exposure repairs using direct closure of conjunctival defect over the GDD or using conjunctival autograft or donor pericardium or sclera.…”

Section: Discussionmentioning

confidence: 98%

“…Thompson et al reported 44% re-exposure rate and attributed this to the use of non-scleral patch grafts in the initial exposure revision. 18 An observational case series by Low et al reported (15%) failure after GDD repair (requiring additional repair procedure) after a mean follow-up of 1.7 years. 19 They used buccal mucous membrane grafts in combination with a lamellar corneal patch graft.…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Thompson et al, more than 60% of eyes with scleral patch graft remained exposure-free long term compared with around 40% of eyes with a non-scleral patch graft. 18 …”

Section: Discussionmentioning

confidence: 99%

“…In the study by Thompson et al, more than 60% of eyes with scleral patch graft remained exposure-free long term compared with around 40% of eyes with a non-scleral patch graft. 18 From our clinical intuition, we had expected that subsequent exposures after the first exposure occurred sooner after the repair. However, we did not find a significant difference between the time to first and subsequent exposures.…”

Section: Discussionmentioning

confidence: 99%

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<p>Tube Revision Outcomes for Exposure with Different Repair Techniques</p>

AlBeshri

Schargel

Ahmad

et al. 2020

OPTH

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Purpose The aim of this study was to report our experience with eyes that presented with an initial GDD exposure and their subsequent outcome in terms of re-exposure. Methods A retrospective review of charts of 42 patients (43 eyes) who presented with a GDD exposure during the period 2008–2015 in a tertiary eye care center was performed. Demographic data, past ocular history, pre-operative and post-operative information including the surgical technique of GDD surgery and exposure repair were recorded. The patients were followed for further exposure to the date of the last follow-up clinic visit. For each type of repair technique, details were collected on risk and timing of GDD exposure. The baseline features of eyes that had further exposure after initial exposure were compared to eyes without further exposure. Results Forty-three eyes were identified which had repair after an initial exposure. The mean ± SD age was 54 ± 27 years. Of the GDDs, Ahmed FP7 was performed in 31 eyes, Ahmed FP8 in two eyes, Ahmed S2 in five eyes, Krupin valve in two eyes and Baerveldt 350 GDD in three eyes. The methods of repair and the relative risk [95% CI] of re-exposure were: conjunctival closure only (n=4; RR=2.10 [0.84–5.23]); repair with patch graft and conjunctival repair (n=18), RR=1.24 [0.51–3.01]; tube repositioning, use of patch graft and conjunctival repair (n=14), RR=1.0; tube removal with replacement in a different quadrant, patch graft and conjunctival repair (n=3), RR=1.87 [0.64–5.48]. After the first exposure, 18 eyes had a second re-exposure, four eyes had a third re-exposure, and 1 eye had a fourth exposure. Conclusions The GDD exposure rates at our institution are consistent with other reports. Lack of a patch graft for repair is associated with a two-fold risk of subsequent re-exposure.

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