Post-operative complications after non-valved glaucoma device implantation due to rapid Polysorb^TM suture absorption time.

Abstract

Purpose : The characteristics of the occlusive absorbable suture used in external tube ligation play a critical role in non-valved glaucoma implant device surgical success. Polysorb and Vicryl are both composed of polyglycolic and polylactic acid with same reported absorption time of 56-70 days¹. The purpose of this retrospective, observational clinical study is to review eight cases of non-valved glaucoma implants using Polysorb suture and report surgical outcomes.

Methods : Clinical records of eight patients at University of Pittsburgh Medical Center Shadyside Hospital between 9/1/2016-11/30/2016 were reviewed. All patients included underwent surgical implantation of a non-valved glaucoma implant device with external tube ligation using Polysorb suture. Pre and post-operative data was collected and reported in this series.

Results : The patients ranged from 47 to 82 years old and had various forms of glaucoma, the most common being Primary open angle glaucoma (POAG). All patients had non-valved glaucoma implant devices placed; Six had Baerveldt Glaucoma Implant 250mm²(BGI) and two had Molteno3(M3). The average pre-operative intraocular pressure was 19.4. The average intraocular pressure after tube opening was 7.9. Five patients (62.5%) had tube opening prior to the 1 month post-op visit. All patients had tube opening by post-operative day 41. Choroidal effusions were present in four patients (50%), anterior chamber shallowing was present in three patients (37.5%), aqueous misdirection occurred in one patient (12.5%). One patient required irido-zonulo-hyaloidectomy for aqueous misdirection. One patient required eventual Penetrating Keratoplasty (PKP) for corneal decompensation. No complications were noted in the Molteno3 implants.

Conclusions : This series analyzes a change in suture from Vicryl to Polysorb and a noticeable difference in tube opening time and post-operative complications. We hypothesize these complications were secondary to early suture release prior to adequate fibrous capsule formation. Not all suture is created equal. The information provided by the manufacturer may be insufficient to make an informed decision with new products. It is unknown how this has impacted other surgeons and we feel further investigation is important to identify a possible preventable risk factor for surgical complications.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.