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      Partial thickness corneal tissue as a patch graft material for prevention of glaucoma drainage device exposure

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          Abstract

          Background

          To protect from erosion of the tube in glaucoma drainage device (GDD), the tube is covered by a biologic tissue which is roofed by the conjunctiva. Sclera, pericardium, dura mater and cornea are available as a patch graft. Drawbacks of some of these materials may include high cost and poor appearance. The purpose of this study is to report the long-term outcomes of partial thickness corneal grafts to cover the tube and prevent its exposure, in GDD surgeries.

          Methods

          This was a retrospective review of all patients who underwent Ahmed glaucoma valve implantation and had a minimum follow-up of 12 months. The tube was covered by a 300-micron partial thickness corneal graft taken either from a previous Descemet stripping endothelial keratoplasty procedure or cut from a whole corneal graft button unsuitable for keratoplasty.

          Results

          Forty-four patients (45 eyes, mean follow-up of 27.6 ± 11.4 months) were enrolled. The partial thickness corneal grafts maintained clarity throughout follow-up with satisfactory cosmetic results. Mild conjunctival retraction occurred in 4 eyes (8.9 %) between 1 and 12 months after the surgery. Corneal graft melting occurred in 3 (6.7 %) eyes. Tube exposure and additional surgery to re-patch or suture the conjunctiva over the tube was needed in 1 (2.2 %) eye. None of the patients had graft infection or immunologic rejection.

          Conclusions

          Partial thickness corneal grafts have favorable long-term outcome as a patch for GDD tubes with low rates of tube exposure and other complications.

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          Most cited references19

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          Late endophthalmitis associated with glaucoma drainage implants.

          To report the clinical course of a series of patients who had late endophthalmitis develop after glaucoma drainage implant (GDI) surgery. Noncomparative, interventional, consecutive case series. Four patients were identified with late endophthalmitis associated with Baerveldt glaucoma implants. The medical records of all patients with endophthalmitis associated with a GDI treated at the Bascom Palmer Eye Institute or University of Florida between January 1, 1987 and December 31, 1999 were retrospectively reviewed. Patients with culture-positive endophthalmitis diagnosed more than 1 month after GDI surgery were included in this series. Visual acuity and intraocular pressure (IOP). Late endophthalmitis associated with Baerveldt glaucoma implants developed 7 weeks to 2 years postoperatively. Exposure of the GDI tube was present in all cases. The implant was removed in three of four patients. Visual acuity worsened from preinfection level in two of four cases. IOP was controlled at last follow-up in all patients, although replacement of the explanted GDI was required in one patient. Late endophthalmitis may occur after GDI surgery. Exposure of the GDI tube seems to represent a major risk factor for these infections. To prevent this potentially devastating complication, we recommend prophylactic surgical revision with a patch graft in all cases in which there is an exposed GDI tube.
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            Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy.

            To compare the long-term results of trabeculectomy and Ahmed glaucoma valve implant in the initial surgical management of primary open- and closed-angle glaucoma. Randomized controlled clinical trial. One eye each of consecutive patients with primary glaucoma and without prior intraocular surgery was randomized to receive either trabeculectomy or the Ahmed implant. Large university-affiliated eye hospital in Columbo, Sri Lanka. Of 123 patients, 64 were randomized to trabeculectomy and 59 to the Ahmed implant. With a mean follow-up of 31 months, the trabeculectomy group had statistically lower intraocular pressures (IOP) during the first postoperative year. After the first year, the IOPs were comparable. No statistically significant differences between groups were noted for postoperative visual acuity, visual field, anterior chamber depth, and short-term or long-term complications. Adjunctive medication requirement was comparable for both groups. The cumulative probabilities of success (IOP <21 mm Hg and at least 15% reduction in IOP from preoperative levels) at the final follow-up period (months, 41-52) were 68.1% for trabeculectomy and 69.8% for Ahmed implant (P =.86). Lower IOPs were noted for the trabeculectomy group during the first year. With longer follow-up, the IOPs and the cumulative probabilities of success were comparable between the two groups.
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              Intermediate-term clinical experience with the Ahmed Glaucoma Valve implant.

              We studied the intermediate-term clinical experience with the Ahmed Glaucoma Valve implant (New World Medical, Inc, Rancho Cucamonga, California). In this multicenter, retrospective case series, we studied 159 eyes (144 patients) treated with the Ahmed Glaucoma Valve with a mean +/- SEM (standard error of mean) follow-up of 13.4 +/- 0.7 months (range, 4 to 44 months). The mean +/- SEM age was 60.9 +/- 1.9 years (range, 0.1 to 103 years). Surgical success was defined as intraocular pressure less than 22 mm Hg and greater than 5 mm Hg without additional glaucoma surgery and without loss of light perception. Postoperative use of antiglaucoma medications was not a criterion for success or failure. The definition of hypotony was intraocular pressure of 5 mm Hg or less in two consecutive visits. Intraocular pressure was reduced from a mean of 32.7 +/- 0.8 mm Hg before surgery to 15.9 +/- 0.6 mm Hg (P < .0001) at the most recent follow-up after surgery. The number of antiglaucoma medications was decreased from 2.7 +/- 0.1 before surgery to 1.1 +/- 0.1 after surgery (P < .0001). The cumulative probability of success was 87% at 1 year and 75% at 2 years after surgery (Kaplan-Meier life-table analysis). Postoperatively, 24 (15%) of 159 eyes had intraocular pressure greater than or equal to 22 mm Hg. The visual acuity was improved or within one Snellen line in 131 eyes (82%). Complications occurred in 75 eyes (47%), the majority of which did not affect surgical outcome. The most common complication was obstruction of the tube, which was observed in 17 eyes (11%). Transient postoperative hypotony was found in 13 eyes (8%). The Ahmed Glaucoma Valve implant is effective in lowering intraocular pressure, and postoperative hypotony is not commonly associated with this implant.
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                Author and article information

                Contributors
                972-54-7277119 , oriels1@yahoo.com
                mwaisbourd@willseye.org
                golanizak@hotmail.com
                hadasng@gmail.com
                rony.rachmiel@gmail.com
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                27 February 2016
                27 February 2016
                2016
                : 16
                : 20
                Affiliations
                [ ]Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 64239 Israel
                [ ]Wills Eye Hospital, Philadelphia, PA USA
                Article
                196
                10.1186/s12886-016-0196-2
                4769544
                26920383
                b98de3e9-bc06-4f5c-918a-1829ef697793
                © Spierer et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 August 2015
                : 10 February 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Ophthalmology & Optometry
                corneal patch graft,glaucoma drainage device,dsek,conjunctival erosion,tube exposure

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