Schipper Pascal, Weber Constance, Lu Ke, Fan Siqi, Prokosch Verena, Holz Frank G, Mercieca Karl
Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
Department of Ophthalmology, University Hospital Cologne, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2025 Apr;263(4):1071-1079. doi: 10.1007/s00417-024-06708-2. Epub 2024 Dec 16.
To evaluate a useful, non-contact method for the follow-up of pericardium patch graft changes in patients undergoing PAUL Glaucoma Implant (PGI) surgery using high-resolution anterior segment optical coherence tomography (OCT) to predict tube erosions.
Prospective analysis over six months of tube pericardium patch graft thickness of PGI surgical cases at the University Eye Hospital Bonn, Germany, from November 2021 to August 2022. In all eyes, Tutopatch (RTI Surgical, United States) pericardium was used to cover the implant intra-operatively. Anterior segment OCT (AS-OCT, Heidelberg ANTERION Swept-Source-OCT) examinations were performed following a standardized protocol to measure quantitative and qualitative aspects of the patch grafts before surgery, and at three and six months after surgery.
Twenty-six eyes of 26 patients were included. Thickness of the patch material was 1188 µm (IQR 415 µm) directly after implantation and decreased over time to 1068 µm (IQR 478 µm) at 3 months and 846 µm (IQR 677 µm) at 6 months. No significant differences between groups were shown concerning gender (p = 0.128), ethnicity (p = 1.000), age (p = 0.741), glaucoma type (p = 0.173), other concurrent diseases (p = 0.302), former glaucoma surgeries (p = 1.000) and the quadrant of implantation (p = 0.555). Five eyes developed implant exposure. When comparing eyes with and without tube exposure, no significant differences were shown in average patch thickness above the tube directly after implantation (p = 0.476). However, significant differences in average thickness were observed at 3 months (p = 0.013) and 6 months (p = 0.005).
Pericardial patch grafts tend to thin over time which can be assessed by AS-OCT, the latter proving to be a useful method to follow-up patients who undergo patch graft implantation during PGI surgery. This investigation could potentially help identify patients at risk of tube exposure which in turn could lead to modification of patient management. It could also possibly be used in future studies to find more suitable patch materials.
评估一种有用的非接触方法，用于对接受PAUL青光眼植入物（PGI）手术的患者的心包补片移植变化进行随访，使用高分辨率眼前节光学相干断层扫描（OCT）来预测引流管侵蚀。
对2021年11月至2022年8月在德国波恩大学眼科医院接受PGI手术的病例进行为期六个月的引流管心包补片厚度的前瞻性分析。在所有眼中，术中使用Tutopatch（美国RTI Surgical公司）心包覆盖植入物。按照标准化方案进行眼前节OCT（AS-OCT，海德堡ANTERION扫频源OCT）检查，以测量手术前、术后三个月和六个月时补片移植的定量和定性方面。
纳入了26例患者的26只眼。植入后补片材料的厚度为1188µm（四分位距415µm），并随时间逐渐减少，在3个月时降至1068µm（四分位距478µm），在6个月时降至846µm（四分位距677µm）。在性别（p = 0.128）、种族（p = 1.000）、年龄（p = 0.741）、青光眼类型（p = 0.173）、其他并发疾病（p = 0.302）、既往青光眼手术（p = 1.000）和植入象限（p = 0.555）方面，各组之间未显示出显著差异。5只眼发生了植入物暴露。比较有和没有引流管暴露的眼时，植入后直接在引流管上方的平均补片厚度没有显著差异（p = 0.476）。然而，在3个月（p = 0.013）和6个月（p = 0.005）时观察到平均厚度有显著差异。
心包补片移植往往会随着时间变薄，这可以通过AS-OCT进行评估，AS-OCT被证明是一种对PGI手术期间接受补片移植的患者进行随访的有用方法。这项研究可能有助于识别有引流管暴露风险的患者，进而可能导致对患者管理的调整。它也可能在未来的研究中用于寻找更合适的补片材料。
