de Luna Regina A, Moledina Ameera, Wang Jiangxia, Jampel Henry D
Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
JAMA Ophthalmol. 2017 Sep 1;135(9):941-946. doi: 10.1001/jamaophthalmol.2017.2628.
Exposure of the tube of an aqueous drainage device (ADD) through the conjunctiva is a serious complication of ADD surgery. Although placement of gamma-irradiated sterile cornea (GISC) as a patch graft over the tube is commonly performed, exposures still occur.
To measure GISC patch graft thickness as a function of time after surgery, estimate the rate of graft thinning, and determine risk factors for graft thinning.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of graft thickness using anterior segment optic coherence tomography (AS-OCT) was conducted at the Wilmer Eye Institute at Johns Hopkins Hospital. A total of 107 patients (120 eyes, 120 ADDs) 18 years or older who underwent ADD surgery at Johns Hopkins with GISC patch graft between July 1, 2010, and October 31, 2016, were enrolled.
Implantation of ADD with placement of GISC patch graft over the tube.
Graft thickness vs time after ADD surgery and risk factors for undetectable graft.
Of the 107 patients included in the analysis, the mean (SD) age of the cohort was 64 (16.2) years, 49 (45.8%) were male, and 43 (40.2%) were African American. The mean time of measurement after surgery was 1.7 years (range, 1 day to 6 years). Thinner grafts were observed as the time after surgery lengthened (β regression coefficient, -60 µm per year since surgery; 95% CI, -80 µm to -40 µm). The odds ratio of undetectable grafts per year after ADD surgery was 2.1 (95% CI, 1.5-3.0; P < .001). Age, sex, race, type of ADD, quadrant of ADD placement, diagnosis of uveitis or dry eye, and prior conjunctival surgery were not correlated with the presence or absence of the graft.
Gamma-irradiated sterile corneal patch grafts do not always retain their integrity after ADD surgery. Data from this cross-sectional study showed that on average, the longer the time after surgery, the thinner the graft. These findings suggest that placement of a GISC patch graft is no guarantee against tube exposure, and that better strategies are needed for preventing this complication.
房水引流装置（ADD）的引流管经结膜外露是ADD手术的一种严重并发症。尽管通常会在引流管上覆盖γ射线辐照的无菌角膜（GISC）作为补片移植，但外露情况仍会发生。
测量GISC补片移植厚度随术后时间的变化，估计移植片变薄的速率，并确定移植片变薄的危险因素。
设计、地点和参与者：在约翰霍普金斯医院的威尔默眼科研究所进行了一项使用眼前节光学相干断层扫描（AS-OCT）对移植片厚度进行的横断面研究。纳入了2010年7月1日至2016年10月31日期间在约翰霍普金斯医院接受ADD手术并植入GISC补片移植的107例18岁及以上患者（120只眼，120个ADD）。
植入ADD并在引流管上放置GISC补片移植。
ADD手术后移植片厚度与时间的关系以及移植片不可检测状态的危险因素。
在纳入分析的107例患者中，队列的平均（标准差）年龄为64（16.2）岁，49例（45.8%）为男性，43例（40.2%）为非裔美国人。术后平均测量时间为1.7年（范围为1天至6年）。随着术后时间延长，观察到移植片变薄（β回归系数为术后每年-60μm；95%置信区间为-80μm至-40μm）。ADD手术后每年移植片不可检测的比值比为2.1（95%置信区间为1.5 - 3.0；P <.001）。年龄、性别、种族、ADD类型、ADD植入象限、葡萄膜炎或干眼的诊断以及既往结膜手术与移植片的有无无关。
γ射线辐照的无菌角膜补片移植在ADD手术后并非总能保持其完整性。这项横断面研究的数据表明，平均而言，术后时间越长，移植片越薄。这些发现表明，放置GISC补片移植并不能保证防止引流管外露，需要更好的策略来预防这种并发症。
