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

• Published in: Acta ophthalmologica (Oxford, England) Vol. 96; no. 7; pp. 692 - 698
• Main Authors: Hoefen Wijsard, Milo, Haan, Michiel, Rietveld, Eelco, Rijn, Laurentius J.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01-11-2018
• Subjects: Adult; Aged; Animals; Antihypertensive Agents - therapeutic use; Baerveldt implant; Cattle; Drainage - methods; Female; Follow-Up Studies; Glaucoma - physiopathology; Glaucoma - surgery; glaucoma drainage device; Glaucoma Drainage Implants; Humans; intraocular pressure; Intraocular Pressure - physiology; Male; Middle Aged; Original; Pericardium - transplantation; Prosthesis Implantation; Retrospective Studies; Sclera - transplantation; Surgical Wound Dehiscence - prevention & control; Suture Techniques; Tissue Donors; Tonometry, Ocular; tube erosion; tube exposure; tutopatch; Visual Acuity - physiology; glaucoma drainage device; intraocular pressure; tube erosion; tutopatch; tube exposure; Baerveldt implant
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.13721

Purpose
To 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.
Methods
All 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.
Results
In 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).
Conclusion
Human 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.