Abstract

Purpose: To determine the safety and efficacy of collagen matrix as a patch graft in glaucoma drainage surgery. Collagen matrix grafts may be advantageous because they do not need to be harvested from human donors. Methods: An institutional, retrospective review of 43 patients with at least 12 months follow-up status post-glaucoma drainage implant surgery were evaluated for signs of tube erosion after initial placement of collagen matrix patch graft. Results: Forty-one of 43 eyes (95.3%) required no intervention for patch graft melting with tube erosion. Average time of follow-up was 32 months (range: 12-45). Two cases had tube erosion at 4 months and 26 months post-op requiring tube revision, which was successfully revised with conjunctiva (4 month erosion) and donor sclera (26 month erosion). Conclusion: Our results suggest that collagen matrix patch grafts may be used successfully as a patch graft in glaucoma tube shunt surgery, and may be advantageous because they do not have to be harvested from human donors. It is possible that exposure rates may be higher after longer follow-up and with larger numbers of patients. Further research is needed to compare Ologen to traditional graft materials to conclusively determine the safety and efficacy of collagen matrix as a novel patch graft material.

Highlights

  • The use of glaucoma drainage implants to treat difficult glaucoma cases has increased in the past two decades[1]

  • Tube shunts in particular carry the risk of patch graft thinning and exposure of the subconjunctival portion of the shunt tube, which is a risk factor for infectious endophthalmitis[3,4]

  • Forty-one of 43 (95.4%) eyes with or pericardial graft with porcine collagen matrix (Ologen) patch graft required no intervention for patch graft melting with tube erosion

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Summary

Introduction

The use of glaucoma drainage implants to treat difficult glaucoma cases has increased in the past two decades[1]. These devices drain aqueous through a silicone tube to a reservoir plate covered by Tenon’s capsule and conjunctiva. The tube is covered by one of several materials to prevent exposure to the overlying conjunctiva. Tube shunts in particular carry the risk of patch graft thinning and exposure of the subconjunctival portion of the shunt tube, which is a risk factor for infectious endophthalmitis[3,4]. Prompt identification and revision of exposed patch grafts with collagenous human autograft or allograft material is recommended[5]

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