Anterior Segment Optical Coherence Tomography-Based Evaluation of Conjunctiva Following Tube Coverage with EverPatch PlusⓇ

Objectives: To evaluate the safety of a novel patch graft, EverPatch PlusⓇ in glaucoma drainage device (GDD) surgery. Methods: We prospectively studied 18 eyes undergoing GDD implantation with EverPatch PlusⓇ and 105 control eyes with conventional scleral patch grafts at Sensho-kai Eye Institute. Postoperative conjunctiva overlying the EverPatch PlusⓇ was studied using anterior segment optical coherence tomography. Patches were secured to the sclera with at least four nonabsorbable sutures. The prevalence of patch extrusion was compared between the EverPatch and control cohorts. Results: In 16 of 18 cases, wounds healed well, and EverPatch remained covered by intact vascularized conjunctiva for >4 months. Conjunctival thickness at 1 mm and 3 mm from the anterior edge of the EverPatch increased by 74% and 87% at two weeks, then returned to baseline by three months. Although conjunctival retraction occurred, EverPatch position relative to the scleral spur remained stable, with no patch-related inflammation. Conjunctival bleaching occurred in two eyes at two months. One case (5.6%), with four prior ocular surgeries developed anterior edge lift-up and patch extrusion on postoperative day (POD) 80. Fluid accumulation around the EverPatch occurred in 8 eyes, resolving within one month in 7; one case with conjunctival bleaching progressed to bleb leak by POD 71. Conjunctival microcysts appeared in 8 eyes, resolving spontaneously within one month. Conclusion: Despite its different material properties from biological patch grafts, EverPatch PlusⓇ may be a viable alternative for tube coverage when firmly secured to the sclera.