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  • Course of Gamma-Irradiated Corneal Patch Grafts After Drainage Device Placement

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, September 2017

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    Although surgically implanted aque­ous drainage devices (ADDs) lower intraocular pressure in patients with glaucoma, the devices often become exposed through the conjunctiva over time. de Luna et al. hypothesized that the thinning of gamma-irradiated sterile cornea (GISC) patch grafts com­monly used to cover the tube of ADDs contributes to this exposure. They found that the risk of a GISC patch graft becoming undetectable increas­es substantially each year after ADD surgery, and their use does not ensure long-term tube coverage.

    This cross-sectional study involved 107 patients (120 eyes) who underwent ADD surgery with a GISC patch graft at Wilmer Eye Institute in Baltimore between July 2010 and October 2016. Of these, 49 were male, and 43 were African American. The patients’ mean age was 64 years (range, 24-96 years), and the mean time since surgery was 1.7 years (range, 1 day to 6 years). Primary outcomes were graft thickness over time and risk factors for unde­tectable grafts. Measurements were obtained by anterior segment optical coherence tomography (AS-OCT) during follow-up exams.

    The linear regression model used to evaluate time after ADD surgery (with graft thickness as the outcome) demonstrated that thinner grafts were observed as time passed (β regression coefficient, −60 μm per year since sur­gery). Moreover, in 16.6% of eyes, no GISC patch graft could be discerned. Each year after ADD surgery, the odds ratio of the graft being undetectable by AS-OCT increased by 2.1. No correla­tion was found between graft presence/absence and age, sex, race, type of ADD, position of ADD, previous conjunctival surgery, or diagnosis of uveitis or dry eye syndrome.

    The original article can be found here.