Use of lyophilized bovine pericardium (Tutopatch®) for surgical management of strabismus

by Mohamed Elabbasy
Doctoral thesis
Date of Examination:2024-11-14
Date of issue:2024-11-01
Advisor:Prof. Dr Michael Schittkowski
Referee:Prof. Dr Michael Schittkowski
Referee:PD Dr. Philipp Kauffmann
Persistent Address: http://dx.doi.org/10.53846/goediss-10828

 

 

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Abstract

English

Objective: This study evaluates the application of lyophilized bovine pericardium (Tutopatch®) as an alternative material for tendon elongation in complex strabismus revision surgeries, addressing challenges posed by traditional methods. Methods: A retrospective analysis was conducted on medical records from patients who underwent revision strabismus surgery using Tutopatch® from 2009 to 2020. Key metrics assessed included preoperative and postoperative deviation angles, ocular motility, binocular vision, and abnormal head posture. These metrics were evaluated at one day, three months, and six months or longer postoperatively. Surgical efficacy was determined through dose-effect relationships, with outcomes categorized as short-term (up to three months) or long-term (six months or more). Results: A total of 83 patients (ages 5 to 75 years; 34 females) met the inclusion criteria, with diagnoses including infantile esotropia (n=25), exotropia (n=17), third nerve palsy (n=9), sixth nerve palsy (n=5), Duane retraction syndrome (DRS) (n=9), dissociated vertical deviation (DVD) (n=5), congenital nystagmus (n=8), and restrictive strabismus (n=5). A significant reduction in deviation angles was observed across diagnoses. Ocular motility outcomes varied considerably due to the inclusion of heterogeneous diagnoses. Binocular single vision improved in 6 out of 11 patients, while the remaining patients required prisms or additional revision surgeries. Improvements in abnormal head posture were notable, with 84% improvement in DRS and 80% in congenital nystagmus cases. Short-term surgical success was achieved in 65% (n=38/59) of patients, decreasing to 37% (n=11/30) over the long term. Biocompatibility was confirmed, with no allergic reactions, granulomas, or infections. Revisions were necessary in 15 patients, all of which were uneventful and exhibited minimal scarring or adhesion to the sclera. Conclusion: Tutopatch® shows promise as a tendon elongation material in complex strabismus revision surgeries, enhancing surgical outcomes by reducing deviation angles and maintaining muscle arc of contact, particularly in cases where conventional options are limited. While initial results are promising, further research with extended follow-up periods is warranted to fully understand the long-term efficacy and durability of Tutopatch® in these complex cases.
Keywords: Strabismus; Revision surgery; Tutopatch®
 
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