Αξιολόγηση της ασφάλειας και της αποτελεσματικότητας φρέσκου, ανθρώπινου, ετερόλογου σκληρικού ιστού με μεθοδολογία οπτικής τομογραφίας συνοχής πρόσθιου ημιμορίου μακροπρόθεσμα ως μόσχευμα κάλυψης στις χειρουργικές επεμβάσεις τοποθέτησης βαλβιδικού μηχανισμού. (Master thesis)

Πλατάρη, Κωνσταντίνα

Introduction : Trabeculectomy has remained the gold standard for glaucoma surgical intervention, but glaucoma drainage devices indications are continuously expanding and growing in popularity during the last 15 years. Even though progress has been made in the design and material technology of these devices over the years, they are still liable for overlying tissue erosion with 1,6% erosion in a follow-up of 18,2 ± 15,4 months and 3-8% in a follow-up of 1-5 years. Erosion of the overlying tissue puts the patient at risk for potentially devastating infection, leading to the development of patch grafts materials used to address exposure of glaucoma drainage devices. Purpose : To determine the safety and efficacy of heterologous, fresh, human donor sclera as patch graft material in glaucoma drainage device surgery using anterior segment optical coherence tomography for the measurement of its thickness as well as the thickness of the overlying epithelium when entering the anterior chamber. Material and Methods : This is initially a retrospective and subsequently a prospective study of 24 patients of the Athens Vision Eye Institute operated by 2 surgeons (Theodoros Filippopoulos and Gerasimos Kopsinis) for glaucoma drainage devices implantations in which heterologous, fresh, human donor sclera was used as patch graft material. Collected data of the patients included demographic characteristics, diagnosis, best- corrected visual acuity, number and type of glaucoma medications before and after the operation, intraocular pressure, Humphrey visual field global indices, central corneal thickness, cup to disc ratio, number and type of previous intraocular surgeries, and previous glaucoma laser procedures. Other data were type of the device (Ahmed or Baerveldt), type of intervention (simple in the anterior chamber or combined with vitrectomy in the pars plana), time from the operation, implantation quadrant, position of the tube in the eye. There were also recorded topical or systematic drugs that can be associated with the healing process such as corticosteroids and antineoplasmatics. If a patient was submitted in bilateral operation, only one eye was randomly selected and used for our study. During the prospective part of the study, collected data included intraocular pressure, glaucoma medications, best-corrected visual acuity, complications and additional surgical interventions recorded on day 1, week 1, and 1 month after surgery and typically at 6,12 months postoperatively and every 6 months thereafter for a maximum of 10 years after the surgery. We performed a cross line scanning over the glaucoma drainage devices tube, at the point where the tube changes its direction and the epithelium is at its most thinner level using anterior segment optical coherence tomography (AngioVue, Fremont, CA). The patients were asked to look towards the direction of the valve tube during the scanning (for example downwards and nasally in the case of an upper valve implantation). We measured both total and the overlying epithelium thickness of the patch graft while entering the anterior chamber. Results : Linear regression analysis between total thickness of the patch graft and time after the Ahmed glaucoma valve surgery was characterized by a satisfying R2=0,4076. We determine that the total thickness of heterologous, fresh, human donor sclera reduces over time. Furthermore, linear regression analysis between the thickness of the overlying epithelium covering the valve tube and time after the Ahmed glaucoma valve surgery was characterized by an R2=0,1148. The thickness of the overlying epithelium doesn't seem to change over time. Conclusions : We determined that heterologous, fresh, human donor sclera as patch graft material in glaucoma drainage device surgery doesn't seem to erode during the time of our follow-up, but presents reduction of its thickness over time, making necessary the frequent review of patients with glaucoma drainage device surgery. To our acknowledgment, is the first time that anterior segment optical coherence tomography is used to confirm the potential erosion of a patch graft material over time in a large field of glaucoma diagnosis.
Institution and School/Department of submitter: Δημοκρίτειο Πανεπιστήμιο Θράκης. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Optical coherence tomography
Keywords: Οπτική τομογραφία συνοχής,Optical coherence tomography,Glaucoma valve,Scleral graft,Βαλβίδες γλαυκώματος,Σκληρικό μόσχευμα
URI: https://repo.lib.duth.gr/jspui/handle/123456789/11910
http://dx.doi.org/10.26257/heal.duth.10692
Appears in Collections:Π.Μ.Σ. ΙΑΤΡΙΚΗ ΑΠΕΙΚΟΝΙΣΗ ΣΤΗΝ ΟΦΘΑΛΜΟΛΟΓΙΑ

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http://dx.doi.org/10.26257/heal.duth.10692
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