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Stephanie A. Low, Dan B. Rootman, Graham E. Trope, David S. Rootman; Buccal Mucous Membrane Grafts Combined With Corneal Lamellar Patch Grafts For The Repair Of Eroded Glaucoma Drainage Devices: Mid-term Outcomes In A Large Series. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2629.
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Glaucoma drainage devices (GDD) are used in the surgical management of medically refractory glaucoma. One rare, but serious late complication is erosion and exposure of the tube or plate. Surgical revisions with autologous conjunctiva alone often result in re-erosion. In these cases, other tissues can be transplanted. In this study, we evaluated the effectiveness of oral buccal mucous membrane allografts with corneal lamellar grafts for the repair of GDD erosions.
All patients who underwent buccal membrane transplants with corneal allografts for the repair of GDD erosions between 2006 and 2010 were included in this retrospective consecutive case series. Primary outcomes were categorized as: a) success: coverage of the GDD without further repair, b) qualified success: minor peri-operative complications or additional procedures required to maintain success, or c) failure: GDD re-erosion requiring surgery.
20 eyes from 18 patients with 21 GDDs were reviewed, of which there were 20 Ahmed valves and 1 Molteno valve. The mean (SD) number of ocular surgeries prior to the buccal membrane transplant was 4.7 (2.9). The mean (SD) time to exposure from the original GDD procedure was 4.3 (3.7) years. Buccal membrane repairs were considered a surgical success in 67% of cases with a mean (SD) follow-up of 1.7 (1.2) years. There were no qualified successes reported. Of the 7 failures, all underwent repeat buccal membrane transplants procedures. Five of these cases had viable grafts covering the GDD at the time of last follow-up, and two required removal of the device.
The use of buccal mucous membrane allografts combined with corneal lamellar patch grafts in the repair of GDD erosions is a useful modality. While not always successful, the procedure may be useful in difficult cases of tube erosion that do not respond to other surgical interventions.
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