Scleral Patch Graft Melt After Tube Shunt Surgery: Grading and Identification of Risk Factors.

PURPOSE

To identify scleral patch graft (SG) melting trends in patients after tube shunt surgery and validate a grading scale for SG health.

METHODS

Patients with glaucoma who underwent tube shunt surgery with a SG were enrolled consecutively at Rutgers New Jersey Medical School from September, 2016 to June, 2017. SG images that were acquired through slit-lamp photography were graded independently by 3 researchers for surface area remaining, thickness and vascularity of the conjunctiva. Interobserver correlation coefficient (kappa) was performed for these scores using our grading system. A chart review of patient records was conducted to investigate comorbid conditions and the student t test was performed with significance P5 years. At those time point: average percentage SG remaining were 72.9, 60, 31.3, 30.7, and 33.3%, respectively (P1 y) and SG thickness score 1.6, 1.2, 0.6, 0.6, and 0.7, respectively (P<0.05 comparing <3 mo to 12 to 24 mo). The rate of SG melt (measured by surface area remaining) over time was higher in patients with ocular surface disease (P<0.01).

CONCLUSIONS

SG melts gradually after tube shunt surgery with the most dramatic melt occurring after 12 months postoperatively. This simple and consistent SG grading scale has high interrater agreement and can be may be used to assess and follow graft health over time.