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Kundandeep S. Nagi, Ricardo J. Cumba, Nicholas P. Bell, Robert M. Feldman, Alice Z. Chuang, Derrick C. Pau; Short Term Safety of KeraSys Patch Graft for Glaucoma Drainage Devices: A Retrospective Case Series. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2637.
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© ARVO (1962-2015); The Authors (2016-present)
To report the safety of using a KeraSys (IOP, Inc. Costa Mesa, California) patch to cover the subconjunctival portion of glaucoma drainage device (GDD) tubes to prevent tube erosion through the overlying conjunctiva.
A retrospective, non-comparative consecutive case series of 40 eyes of 36 patients who underwent first time GDD surgery with KeraSys patch grafts to cover the subconjunctival portion of the tube was perfomed. Main outcome measurements included tube related complications i.e. patch exposure, tube erosion, wound dehiscence, and patch migration. Data was summarized and compared using paired t-test. All analyses was performed using SAS for Window 9.2 (Cay, NC). A p-value <0.05 was considered as statistically significant.
Forty eyes were followed for an average of 3.7 ± 3.2 months. Two (5%) eyes experienced tube related complications. One eye had tube and nylon suture exposure through overlying conjunctiva that was discovered 8 months postoperatively, after being lost to followup for 6 months. Vicryl sutures were used intraoperatively for conjunctival closure. Surgical revision was promptly performed. The patient was diabetic, hypertensive, and had underwent multiple previous intraocular surgeries including vitrectomy in the eye. Another eye underwent inferonasal GDD surgery using KeraSys with combined conjunctivoplasty (autologous conjunctival graft) to cover the tube and graft given that the tissue in the inferonasal quadrant was found to be inadequate. In the early post-operative period (3 weeks), the KeraSys was noted to be exposed and was management conservatively. 1 week later, the tube was exposed and surgical intervention was pursued. The patient was diabetic, hypertensive, and had undergone multiple previous intraocular surgeries in the eye including trabeculectomy and cyclophotocoagulation. 1 patient had early (3 week) dehiscence of the conjunctival wound away from the graft that has not required surgical intervention.
We report our early experience with KeraSys, bioengineered lamellar porcine small intestinal mucosa, as a material to cover the subconjunctival portion of GDD tubes. Of the 40 eyes, 2 eyes experienced early patch related complications. Both were in high-risk eyes. The early exposure rate is similar to previous studies with other materials.
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