ABSTRACT
Purpose: Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts had been used to cover the tube. Methods: Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared. Results: Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01). Conclusion: There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.
ABSTRACT
The hydroxyapatite orbital implant has been known to be a biocompatible and nontoxic implant with good fibrovascular ingrowth, few postoperative complications, and excellent prosthesis motility. The complications after implantation of hydroxyapatite were included peg extrusion, implant exposure, conjunctival dehiscene, granulation tissue overgrowth, and infection of implant. Infected hydroxyapatite implants are, to date, rare. When they occur, implant removal has been the only successful treatment modality. Infection of hydroxyapatite implant occurred in 37months after surgery on conjuctival culture. Pseudomonas aeruginosa was identified as a causative microorganism. To our knowledge, this is the first report of complications with the latest infected hydroxyapatite after implantation of hydroxyapatite. The case also unique because causative microorganism is Pseudomonas aeroginosa instead of Staphylococcus aureus. Persistent conjunctival inflammation postoperatively despite using systemic and topical antimicrobial drops, persist orbital discomfort, discharge, conjunctival dehiscence and the development of a pyogenic grauloma after hydroxyapatite implant should be suspected possibility of hydroxyapatite implant infection.