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Caroline N Pham, Daniel Vu, Christopher Starr, Nathan M Radcliffe; Outcomes associated with reduced suture placement during glaucoma tube shunt implantation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2705.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the outcomes of different surgical techniques for glaucoma tube shunt surgery through sutureless placement of the patch graft, tube plate, and/or tube including intraocular pressure (IOP) changes and complications.
This was a retrospective cohort study of consecutive surgeries in which tube shunts were placed using various techniques between July 2008 and September 2013. Patients were divided into groups based on whether the patch graft (PG), tube plate, and/or tube were sewn or simply placed without anchoring sutures. Operative details including the tube shunt device type and location of tube tip placement were recorded. Baseline and post-op IOP measurements, number of glaucoma medications, and adverse events were documented and compared using two sample t-tests.
For 85 participants of mean age 63.0 ± 18.5, the mean baseline IOP was 27.7 ± 9.5 mm Hg. While 20 patients had the tube shunt device placed using a sewn PG/plate/tube, 16 had a sewn plate/tube, 25 had only a sewn tube, and the remaining 24 had sutureless placement of the PG, plate, and tube. The conjunctiva was sewn closed with 8-0 polyglactin in all cases. Following implantation of the tube shunt device, IOP at post-op day 1, week 1, and month 1 were 16.6 ± 10.5 mm Hg, 18.3 ± 12.2 mm Hg, and 18.8 ± 10.0 mm Hg, respectively (p<0.0001). The decrease in number of glaucoma medications at baseline and post-op visits was also statistically significant (p<0.0001). There were no significant differences for IOP reduction and number of medications at each visit between the groups based on surgery technique. Furthermore, 0% of patients experienced any PG/tube/plate migration or any cases of exposed tube due to patch graft migration.
Sutureless placement of the patch graft, plate, and/or tube during glaucoma tube shunt implantation is associated with comparable outcomes versus the traditional technique. Performance of this technique reduces the overall number of steps in the surgical procedure. There were no cases of any tube shunt migration or receding conjunctiva in this study.
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