Repair of Exposed Ahmed Glaucoma Valve Tubes: Long-term Outcomes.
Einan-Lifshitz Adi, Belkin Avner, Mathew David, Sorkin Nir, Chan Clara C, Buys Yvonne M, Trope Graham E, Rootman David S
AI Summary
This study found repairing exposed glaucoma drainage tubes with buccal mucous membrane and corneal grafts is a highly effective, long-term solution, offering good clinical success for patients.
Abstract
Purpose
To assess the long-term outcomes of glaucoma drainage device (GDD) exposure repair with corneal lamellar patch graft covered by a buccal mucous membrane graft sutured to surrounding conjunctiva.
Methods
In this retrospective longitudinal study, the charts of all patients who underwent buccal mucous membrane grafts combined with corneal lamellar patch grafts for exposed GDD tubes between the years 2006 to 2013 were reviewed. A minimum follow-up of 3 years was required for inclusion. Primary outcomes were categorized as complete success: adequate coverage throughout the study period without further intervention after 1 repair; qualified success: adequate coverage despite minor additional procedures (eg, suturing); failure: re-erosion of the GDD tube.
Results
A total of 23 tube exposures were included. Average time from GDD insertion to first erosion was 54.0±38.9 months (range, 5 to 120). Complete success was achieved in 19 cases (82.6%), and qualified success in 1 case (4.3%). There were 3 failures (13.1%). Overall success (complete+qualified) after 1 or 2 buccal mucous membrane graft repairs was achieved in 22 of 23 cases (95.7%). Average follow-up time for the successful cases (complete+qualified) was 69.5±25.4 months (median, 72.5; range, 36 to 124). There was no difference in time to first erosion between the success (complete+qualified) and failure groups: 53.8±38.3 months (range, 5 to 120) and 62.3±51.6 months (range, 5 to 105), respectively (P=0.78).
Conclusions
Buccal mucous membrane grafts in combination with a lamellar corneal patch graft is a viable surgical strategy for eroded GDDs, providing good long-term outcomes; however, later interventions may be needed.
MeSH Terms
Shields Classification
Key Concepts6
The average time from Glaucoma Drainage Device (GDD) insertion to first erosion was 54.0 38.9 months (range, 5 to 120 months) in 23 cases of exposed GDD tubes.
Complete success, defined as adequate coverage throughout the study period without further intervention after 1 repair, was achieved in 19 out of 23 cases (82.6%) for exposed Glaucoma Drainage Device (GDD) tubes repaired with buccal mucous membrane grafts combined with corneal lamellar patch grafts.
Overall success (complete + qualified success) after 1 or 2 buccal mucous membrane graft repairs for exposed Glaucoma Drainage Device (GDD) tubes was achieved in 22 of 23 cases (95.7%), with an average follow-up time for successful cases of 69.5 25.4 months (median, 72.5 months; range, 36 to 124 months).
There was no statistically significant difference in time to first erosion between the success (complete + qualified) and failure groups for Glaucoma Drainage Device (GDD) tube repair, with times of 53.8 38.3 months (range, 5 to 120 months) and 62.3 51.6 months (range, 5 to 105 months) respectively (P=0.78).
Buccal mucous membrane grafts in combination with a lamellar corneal patch graft is a viable surgical strategy for eroded Glaucoma Drainage Devices (GDDs), providing good long-term outcomes, though later interventions may be needed.
A retrospective longitudinal study reviewed charts of patients who underwent buccal mucous membrane grafts combined with corneal lamellar patch grafts for exposed Glaucoma Drainage Device (GDD) tubes between 2006 and 2013, requiring a minimum follow-up of 3 years for inclusion.
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