Korean J Ophthalmol.  2008 Dec;22(4):268-271. 10.3341/kjo.2008.22.4.268.

Pericardium Plug in the Repair of the Corneoscleral Fistula After Ahmed Glaucoma Valve Explantation

• Yoo C
• Kwon SW
• Kim YY

• KMID: 1084217
• DOI: http://doi.org/10.3341/kjo.2008.22.4.268

Abstract

We report four cases in which a pericardium (Tutoplast(R)) plug was used to repair a corneoscleral fistula after Ahmed Glaucoma Valve (AGV) explantation. In four cases in which the AGV tube had been exposed, AGV explantation was performed using a pericardium (Tutoplast(R)) plug to seal the defect previously occupied by the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast(R)), measured 1 mm in width, was plugged into the fistula and secured with two interrupted 10-0 nylon sutures. To control intraocular pressure, a new AGV was implanted elsewhere in case 1, phaco-trabeculectomy was performed concurrently in case 2, cyclophotocoagulation was performed postoperatively in case 3 and anti-glaucomatous medication was added in case 4. No complication related to the fistula developed at the latest follow-up (range: 12~26 months). The pericardium (Tutoplast(R)) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants.

Keyword

Ahmed glaucoma valve; Corneoscleral fistula; Pericardium plug

MeSH Terms

Adolescent
Corneal Diseases/etiology/*surgery
Device Removal/adverse effects
Fistula/etiology/*surgery
*Glaucoma Drainage Implants
Glaucoma, Neovascular/*surgery
Humans
Intraocular Pressure
Male
Middle Aged
Pericardium/*transplantation
*Postoperative Complications
Reoperation
Scleral Diseases/etiology/*surgery
Suture Techniques

Figure

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  Fig. 1 Exposure of the tube and the body of the preexisting Ahmed Glaucoma Valve is shown with complete melting of the pericardium patch graft. The body of the AGV was located 4 mm posteriorly to the limbus.

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  Fig. 2 Schematic illustration of the pericardium plug (black arrow) which is secured with 10-0 Nylon sutures (white arrow) to seal the defect previously occupied by the silicone tube of Ahmed glaucoma valve.

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  Fig. 3 (A) Slit-lamp photo shows the tube exposed externally through overlying conjunctival erosion. (B) Slit-lamp photo shows the pericardium plugged (black arrow) in the corneal fistula at 12 months after AGV explantation.

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  Fig. 4 (A) Slit-lamp photo shows the tube exposed externally through the overlying conjunctival erosion. Hypopyon is also noted. (B) Slit-lamp photo shows the pericardium plugged (black arrow) in the corneal fistula at 7 months after AGV explantation.

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