Stone Donald U, Craven Earl Randy, Ahmad Sameer I, AlBeshri Ali, Owaidhah Ohoud A
Department of Research, ReWilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Middle East Afr J Ophthalmol. 2019 Sep 30;26(3):148-152. doi: 10.4103/meajo.MEAJO_78_18. eCollection 2019 Jul-Sep.
Glaucoma drainage device surgery (GDDS) has gained popularity, with outcomes equivalent to trabeculectomy. Erosion of the tube through the overlying conjunctiva may occur in 5%-10% of eyes. Donor corneal tissue has been used as a patch graft for GDDS.
This was a prospective proof of concept study in 10 patients undergoing GDDS. From patients undergoing endothelial keratoplasty, the donor tissue (approximately 300 μ in thickness) was placed epithelial side down in a well and was allowed to soak in riboflavin solution (VibeX, Avedro, Waltham, MA, USA) for 15 min. This anterior corneal lenticule received 8 mW/cm ultraviolet (UV) irradiation applied for 15 min (total energy of 7.2 J/cm). Each lenticule was then bisected and utilized for the two study participants. The tissue was sutured over the tube during the GDDS and then was covered with recipient conjunctiva as per the usual technique. Representative graft tissues were fixed and examined to determine the depth of cross-linking effect. The patients were followed for 1 year.
Histology revealed no apparent demarcation line in the cross-linked grafts; this supported a full-thickness cross-linking treatment effect. There were no intra- or postoperative complications attributed to the graft tissue. No patient developed erosion or exposure of the tube during the 1-year follow-up.
UV-riboflavin cross-linking of the corneal tissue patch graft material appears to be a safe modification when used in GDDS and warrants ongoing study. This method of patch graft can replace other costy methods used with GDD.
青光眼引流装置手术（GDDS）已越来越受欢迎，其效果与小梁切除术相当。5%-10%的患者可能会出现引流管穿透上方结膜的情况。供体角膜组织已被用作GDDS的补片移植材料。
这是一项针对10例行GDDS患者的前瞻性概念验证研究。从接受内皮角膜移植术的患者获取供体组织（厚度约300μm），上皮面朝下置于培养皿中，浸泡在核黄素溶液（VibeX，Avedro，美国马萨诸塞州沃尔瑟姆）中15分钟。这片前角膜透镜接受8mW/cm的紫外线（UV）照射15分钟（总能量为7.2J/cm）。然后将每个透镜一分为二，供两名研究参与者使用。在GDDS手术期间，将该组织缝合在引流管上，然后按常规技术覆盖受体结膜。对代表性的移植组织进行固定和检查，以确定交联效果的深度。对患者进行了1年的随访。
组织学检查显示交联移植片中无明显分界线；这支持了全层交联治疗效果。没有因移植组织导致的术中或术后并发症。在1年的随访期间，没有患者出现引流管侵蚀或暴露。
角膜组织补片移植材料的紫外线-核黄素交联在用于GDDS时似乎是一种安全的改良方法，值得继续研究。这种补片移植方法可以替代用于青光眼引流装置的其他昂贵方法。
