C Yoo, et al. PERICARDIUM PLUG IN CORNEOSCLERAL FISTULA REPAIR Table 1. Summary of the features of 4 cases in whom a pericardial plug was used to repair the corneoscleral fistula after Ahmed Glaucoma Valve had been explanted. Case SAegxe/ Dx Va PIOrePop(mmHg) Previous OP Combined OP Va PIoOsPtop(mmHg) Additional measures 1 (OD) M/49 NVG 0.15 40 PE 2nd AGV 0.2 18 none AGV 2 (OS) M/61 NVG FC 9 AGV PE HM 13 none Trab 3 (OS) M/56 NVG HM 15 PPV None HM 14 CPC PE AGV 4 (OS) M/17 CG 0.04 6 Trabeculotomy None 0.02 17 Cosopt & Trab Alphagan-P 2 AGVs added Dx=diagnosis; Preop=preoperative; Postop=at the last postoperative visit; Va=visual acuity; IOP=intraocular pressure; OP= operation; NVG=neovascular glaucoma; CG=congenital glaucoma; FC=finger count; HM=hand motion; PE=phacoemulsification and intraocular lens implantation; AGV=Ahmed glaucoma valve implantation; PPV=pars plana vitrectomy; Trab=trabeculectomy; CPC=cyclophotocoagulation. 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. AGV in another quadrant because we believed that the preexisting AGV was non-functioning and pain-evoking. In addition, we believed that insertion of a new AGV into the same place might predispose the patient to a recurrence of exposure. Under peribulbar anesthesia, a conjunctival peritomy was performed alongside the area of transconjunctival tube erosion, and the tube of the AGV was removed from the anterior chamber. To seal the space previously occupied by the tube, the fistula was debrided with a No. 11 Bard-Parker blade and a Weckcel® sponge. A piece of processed pericardium (Tutoplast®), measured 1 mm in width, was then plugged into the fistula. The pericardium was trimmed flush to the external opening and secured with two interrupted 10-0 nylon sutures (Fig. 2). Next, the plate of the AGV was explanted from the underlying sclera. The conjunctiva was drawn back in place and sutured. For implantation of a new AGV, a fornix-based incision was made through the 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. conjunctiva and the Tennon’s capsule at the superonasal quadrant. A pocket was created between the superior rectus and the medial rectus muscles by blunt dissection of the Tennon’s capsule from the episclera. A new valve body was inserted into the pocket with its leading edges 8 mm posterior to the limbus. The tube of the valve was trimmed to permit a 2 mm insertion into the anterior chamber. A paracentesis was performed, and the anterior chamber was entered at the limbus with a sharp 23 G needle, parallel to the iris. The drainage tube was inserted through the needle track. The tube was secured to the sclera with two 10-0 Nylon sutures, and covered with pericardium (Tutoplast®). The conjunctiva and the Tennon’s capsule were closed with 10-0 Nylon sutures. The IOP ranged from 8 to 20 mmHg during the postoperative one month. At postoperative 14 months, IOP was 18 mm Hg and no fistula-related complication such as wound dehiscence or pericardium melting was noted. 269