Abstract
BackgroundThe use of a tissue patch graft is common practice with a glaucoma drainage device (GDD). Patch grafts can be visible in the palpebral fissure and may be cosmetically displeasing for some patients. The aim of this study was to report the cosmetic satisfaction of pericardial, scleral, and corneal patch grafts related to superior GDD surgery.MethodsBaseline clinical data were collected for consecutive patients with glaucoma operated between 2014 and 2019 at two tertiary eye care institutions (for superiorly-placed) Ahmad glaucoma valve implant using sclera, cornea and pericardium patch graft. A patient questionnaire that contained 4 concise questions, with a Likert-scale grading relating to cosmetic satisfaction was administered by a telephone-based interview. Responses and scores for each question were compared across patients who received the three different types of graft. A binominal logistic regression analysis was used to assess the effects of age, gender, type of graft, number of previous ocular surgeries, and final visual acuity to explain differences.ResultsWe included 92 patients who met our inclusion criteria (24 patients received a corneal patch graft, 30 who received sclera and 38 who received pericardium). The mean (±SD) age was 50 (±17.5) years, and the average follow up was 20.7 (± 18.6) months. Regardless of the type of patch graft, most (67–84%) of patients were satisfied with the appearance of their eyes. Patients who received cornea or sclera were more likely to report that their eye looked ‘abnormal’ by others. Younger age was significantly associated with the response to this question.ConclusionPatients are generally satisfied with the appearance of their eye following GDD surgery with each of the patch grafts for superiorly-placed GDDs. Younger patients with cornea or sclera were more likely to report that their eyes looked abnormal.
Highlights
The use of a tissue patch graft is common practice with a glaucoma drainage device (GDD)
The present study aimed to study patient satisfaction related to the appearance of the patch graft for patients who received pericardium, sclera, or corneal patch graft related to GDD surgery
One hundred and five consecutive patients who underwent to Ahmad glaucoma valve implant with different patch grafts and met the inclusion criteria were included in the study
Summary
The use of a tissue patch graft is common practice with a glaucoma drainage device (GDD). Glaucoma drainage devices (GDD) are traditionally reserved for glaucomas which are refractory to filtering surgery or in cases where trabeculectomy is at high risk for failure, these are assuming a greater role in the primary surgical management of glaucoma [1, 2]. These devices lower the intraocular pressure by forming a space between the sclera and the conjunctiva to allow aqueous outflow. Tube exposure and erosion of the overlying patch graft and the conjunctiva is a potentially serious complication and well-known risk factor for the development of endophthalmitis. Covering the tube with host sclera or donor patch graft is essential to prevent conjunctival erosion, and subsequent complications [4, 5]
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