Biodegradable Implant for Tissue Repair After Glaucoma Drainage Device Surgery
ABSTRACT To report a novel technique using biodegradable material to cover exposed glaucoma tube shunts.
A case report of a single patient who underwent drainage tube shunt surgery with the Baerveldt drainage device for intractable glaucoma. Four months post operation the tube became exposed through necrosis of the overlying scleral flap and conjunctiva. The defect was repaired by fixation of the tube to the sclera, with a slice of an ologen implant as a patch, covered by the adjacent conjunctiva. The patient was followed over a period of 1 year after the surgery.
Successful, lasting closure of the conjunctival defect was achieved without any side effects or complications.
Erosion of the drainage tube after shunt surgery is a potentially serious problem. It can be successfully managed using a biodegradable implant as a patch before closing the conjunctiva.
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ABSTRACT: Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain. In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure. Glaucoma is a disease of the optic nerve that affects approximately 60 million people globally. It is the second most common cause of blindness, leaving an estimated 7.5 million people blind. In India it affects 11 million people, of which 1.5 million are blind. Glaucoma is a disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness. Glaucoma is the leading cause of irreversible blindness in the world. Glaucoma usually causes no symptoms early in its course, at which time it can only be diagnosed by regular eye examinations and screenings with the frequency of examination based on age and the presence of other risk factors. Intraocular pressure increases when either too much fluid is produced in the eye or the drainage or outflow channels of the eye become blocked. While anyone can get glaucoma, some people are at greater risk. The two main types of glaucoma are open-angle glaucoma, which has several variants and is a long duration condition, and angleclosure glaucoma, which may be a sudden condition or a chronic disease. Damage to the optic nerve and impairment of vision from glaucoma is irreversible. Several painless tests that determine the intraocular pressure, the status of the optic nerve and drainage angle, and visual fields are used to diagnose glaucoma. Glaucoma is usually treated with eye drops, although lasers and surgery can also be used. Most cases can be controlled well with these treatments, thereby preventing further loss of vision. Much research into the causes and treatment of glaucoma is being carried out throughout the world. Early diagnosis and treatment is the key to preserving sight in people with glaucoma.
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ABSTRACT: AIM: Biodegradable collagen glycosaminoglycan matrices (CGM) have been introduced to glaucoma filtration surgery in order to prevent scarring of the filtering bleb. In this retrospective case series, we describe a new surgical concept for treating symptomatic ocular hypotony following filtration surgery with mitomycin C by a secondary subconjunctival implantation of a CGM. METHODS: Depending on bleb morphology, a CGM implant with a diameter of 6 or 12 mm was placed subconjunctivally on the scleral flap in 12 eyes displaying symptomatic ocular hypotony with (n=2) or without (n=10) bleb leakage. Median period between trabeculectomy and this intervention was 4.5 months (range, 1-72 months). RESULTS: Mean intraocular pressure significantly increased from 4.4±1.4 mm Hg to 9.9±2.8 mm Hg (p<0.0001) over a median follow-up of 6 months (range, 2-18 months). Mean visual acuity improved significantly (p=0.0012). Postoperative complications included implant re-exposure in one eye and persistent choroidal detachment requiring resurgery in another eye. CONCLUSIONS: Subconjunctival implantation of CGM may present an additional surgical tool in the treatment of symptomatic ocular hypotony after filtering surgery. The mechanism of action may be counter-pressure to the scleral flap and secondary wound healing around the CGM scaffold. Long-term observations are needed to fully evaluate this new surgical concept.The British journal of ophthalmology 06/2013; 97(8). DOI:10.1136/bjophthalmol-2013-303357 · 2.81 Impact Factor