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Benjamin Daniel Abramowitz, Marlene Moster, Michael Pro, Courtland Schmidt, Elizabeth Dale, Edward Stephen Yung, Alice Williams; Pilot Study Assessing the Use of High-Density Polyethylene (Su-Por®) for Tube Shunt Patch Grafts. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4970.
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Given the rising costs of healthcare, measures to provide cost-effective yet high quality care are of the upmost importance. Current approaches to cover tube shunts and reduce the incidence of tube exposure most commonly utilize sterilized human tissue (ie pericardium, sclera, cornea). This FDA-approved high-density polyethylene biomaterial has been successfully used for orbital and facial reconstruction. Our pilot study assessed the viability of this manufactured, cost-effective patch graft material for prevention of tube exposure.
The first 11 patients from the Wills Eye Hospital Glaucoma Service to receive the graft were assessed in a retrospective manner. Tube shunt implantation was performed in the standard manner using a fornix-based conjunctival incision. Once the tube was inserted into the anterior chamber, the aforementioned patch graft was placed over the scleral portion of the tube and sutured to the sclera. A standardized survey provided by the manufacturer was utilized to document the success of the patch.
In three months following surgery, seven patients had an uneventful post-operative course without graft-related complications. Among the 11 patients, four (36.3%) experienced an extrusion of the patch without a leak at 1.5-2.5 months after the original surgery. All patch extrusions occurred along the anterior edge of the patch graft. One patient was asymptomatic and over time developed epithelialization over the area of extrusion. The remaining three patients presented with symptomatic extrusion. Progressive extrusion required revision in the operating room. No patient experienced any sign of infection despite the extrusions.
The high-density polyethylene patch graft provides a more cost-effective alternative to sterilized human tissue for covering tube shunts at the time of implantation. However, the more rigid material of the patch may promote extrusion of the graft itself in a significant number of patients. Therefore, this material should be considered a less viable alternative to currently available patch grafts.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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