Tendon Elongation with Bovine Pericardium (Tutopatch®) When Conventional Strabismus Surgery is Not Possible

Rijn, L.J. van; Ven, Stephanie J N van De; Krijnen, Jacqueline S M; Jansen, Suzanne M; Bakels, A.J.; Langenhorst, A.E.L.

doi:10.5301/ejo.5000689

Cited by 19 publications

(29 citation statements)

References 32 publications

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“…Within the bovine pericardium, 58% received a drainage suture. It is being observed that bovine pericardium material functions as a matrix for the ingrowth of the bodies' own connective tissue (van Rijn et al 2016). A drainage suture could cause intraocular fluid to accumulate around the patch graft material and in the case of bovine pericardium limit the ingrowth of connective tissue leading to melting of the patch graft.…”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis is supported by our observation that the drainage suture tends to increase the rate of tube exposure. As in instances where bovine pericardium is not surrounded by intraocular fluid, melting of the material is not being observed (van Rijn et al 2016). In this current study, despite a trend in the survival analysis and an odds ratio of 3.45, a significant association between tube exposure and drainage sutures within the bovine pericardium cohort could not be demonstrated, however.…”

Section: Discussionmentioning

confidence: 99%

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Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Wijsard

Haan

Rietveld

et al. 2018

Acta Ophthalmologica

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PurposeTo compare the use of human donor sclera with bovine pericardium as patch graft material for a glaucoma drainage device (GDD), with respect to the incidence of tube exposure, and to study the role of a drainage suture.MethodsAll GDD surgeries between 2010 and 2014 performed at the VU Medical Center were examined in this comparative, retrospective cohort study. A total of 244 cases were included; 163 in the human donor sclera cohort and 81 in the bovine pericardium cohort with a median follow‐up of 31 and 36 months, respectively. The primary outcome measure was occurrence of tube exposure. Survival analysis for tube exposure was carried out and Kaplan–Meier curves compared. Secondary outcomes were postoperative intraocular pressure (IOP), number of glaucoma medications and the effect of a drainage suture.ResultsIn the bovine pericardium cohort, eleven (13.6%) eyes developed tube exposure compared to none in the human donor sclera cohort. Their Kaplan–Meier survival curves differed significantly from each other (χ² = 21.1, p < 0.001, log‐rank test). Mean IOP and number of glaucoma medications did not differ significantly between patch graft materials at three months of follow‐up. The use of a drainage suture directly lowered IOP after surgery in both cohorts. Within the bovine pericardium cohort, eyes with a drainage suture experienced more tube exposure, although this difference was not statistically significant (p = 0.09).ConclusionHuman donor sclera leads to less tube exposure than bovine pericardium. A drainage suture directly lowers IOP after surgery. With bovine pericardium, but not with donor sclera, exposure tends to be enhanced by a drainage suture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Wijsard

Haan

Rietveld

et al. 2018

Acta Ophthalmologica

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“…Weiterhin traten trotz großer Rücklagerungs-/Sehnenverlängerungsstrecken keine störenden divergenten Schielstellungen in der Nähe auf, obwohl sich die Adduktion vor allem nach Sehnenverlängerung deutlich verringerte. Inzwischen wird die Sehnenverlängerung mit bovinem Perikard auch bei anderen Erkrankungen mit großen Schielwinkeln erfolgreich eingesetzt [23,26].…”

Section: Diskussionunclassified

“…Bovines Perikard durchläuft mehrfache Fertigungsschritte, um jegliche Pathogene zu inaktivieren und Bakterien zu entfernen. Es dient als Gerüst für den zellulären Reparaturmechanismus und wird innerhalb von Wochen bis Monaten durch körpereigenes Narbengewebe ersetzt [23]. Dadurch sind weniger Nebenwirkungen, wie Abstoßung und Infektion, als bei artifiziellen, inerten Materialien zu erwarten.…”

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Korrektur horizontaler Schielwinkel nach Dekompressionsoperation bei Patienten mit endokriner Orbitopathie – Vergleich von Sehnenverlängerung und einfacher Rücklagerung des M. rectus medialis

Oeverhaus

Fischer

Schlüter

et al. 2018

Klin Monatsbl Augenheilkd

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Zusammenfassung Hintergrund Patienten mit endokriner Orbitopathie (EO) können nach knöcherner Dekompressionsoperation sehr große horizontale Schielwinkel entwickeln, vor allem wenn präoperativ eine massive Muskelverdickung vorliegt. Diese großen Schielwinkel können häufig nicht ausreichend mit Rücklagerungen der Mm. recti mediales korrigiert werden. Eine Sehnenverlängerung mit Interponat aus bovinem Perikard (Tutopatch®) ist dann eine Alternative zur gleichzeitigen Resektion des M. rectus lateralis. Wir berichten hier über unsere klinischen Erfahrungen mit Operationen am M. rectus medialis nach knöcherner 3-Wand-Dekompression. Methoden Patienten mit ein- und beidseitigen Medialis-Rücklagerungen (MR, BMR) (n = 87) und beidseitigen Medialis-Rücklagerungen kombiniert mit Sehnenverlängerung (n = 60) durch Interponat, an einer oder beiden Seite(n) wurden hinsichtlich des operativen Erfolgs (Restschielwinkel ≤ 5° ggf. ausgeglichen mit Prismen, doppelbildfreies Gebrauchsblickfeld – zentrale 20° mit Kopfzwangshaltung ≤ 10°), der Dosis-Wirkungs-Beziehung (DWB; °/mm) und der postoperativen Augenmotilität retrospektiv nach 3 und 12 Monaten analysiert. Ergebnisse In allen Patientengruppen zeigte sich eine deutliche geringere Dosis-Wirkungs-Beziehung im Vergleich zur MR ohne vorangegangene Dekompression: 1,2 ± 0,4°/mm für die einseitige (MR) und 1,0 ± 0,3°/mm für die beidseitige Medialis-Rücklagerung (BMR); 0,92 ± 0,3°/mm für die einseitige Sehnenverlängerung kombiniert mit einer MR am anderen Auge (BMR + IP) und 0,87 ± 0,3°/mm für die beidseitige Sehnenverlängerung (BMR + BIP). Da bei der präoperativen Planung eine höhere DWB angenommen wurde, war ein großer Teil der Patienten postoperativ unterkorrigiert. Unter Berücksichtigung der tatsächlichen DWB ergeben sich auch bei diesen sehr schwer erkrankten EO-Patienten akzeptable OP-Erfolgsraten: Bei einfacher Rücklagerung um 90% und bei Sehnenverlängerung um 70%. Schlussfolgerung Nach knöcherner Orbitadekompression muss man Medialis-Rücklagerungen bzw. Rücklagerungen in Kombination mit Sehnenverlängerung höher dosieren als bei Patienten ohne vorangegangene Dekompression. Einfache Rectus-medialis-Rücklagerungen sind deshalb nur bis zu einem Schielwinkel von 15° sinnvoll. Bei größeren Schielwinkeln bis 25° kann man Interponate einsetzen.

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Tendon elongation with bovine pericardium in strabismus surgery—indications beyond Graves’ orbitopathy

Hedergott

Pink-Theofylaktopoulos

Neugebauer

2020

Graefes Arch Clin Exp Ophthalmol

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Background For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves’ orbitopathy in which it is already widely used. Methods We reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves’ orbitopathy were excluded. Results From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3–75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane’s retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1–5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane’s retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered. Conclusions Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.

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Tendon Elongation with Bovine Pericardium (Tutopatch®) When Conventional Strabismus Surgery is Not Possible

Abstract: Tendon elongation is a valuable addition to our strabismus surgery repertoire. However, because of duction limitations after surgery, it should be reserved for those cases in which conventional surgery is not an option.

Cited by 19 publications

References 32 publications

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Korrektur horizontaler Schielwinkel nach Dekompressionsoperation bei Patienten mit endokriner Orbitopathie – Vergleich von Sehnenverlängerung und einfacher Rücklagerung des M. rectus medialis

Tendon elongation with bovine pericardium in strabismus surgery—indications beyond Graves’ orbitopathy

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