Korean Journal of Ophthalmology 2008;22:268-271 ISSN : 1011-8942 DOI : 10.3341/kjo.2008.22.4.268 Pericardium Plug in the Repair of the Corneoscleral Fistula After Ahmed Glaucoma Valve Explantation Chungkwon Yoo, MD, Sung Wook Kwon, MD, Yong Yeon Kim, MD, PhD Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea We report four cases in which a pericardium (Tutoplast®) 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 ) plug to seal the defect previously occupied by ® the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast ), 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 ) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants. Korean J Ophthalmol 2008;22:268-271 ⓒ 2008 by the Korean Ophthalmological Society. Key Words: Ahmed glaucoma valve, Corneoscleral fistula, Pericardium plug Glaucoma drainage implants (GDIs) have been an effective therapeutic option in the management of refractory glaucoma. The complications associated with GDIs, however, include hypotony, choroidal effusion, corneal decompensation, cataract, endophthalmitis, diplopia, and migration of the implant.1,2 Erosion of the silicone tube through the overlying conjunctiva has also been recognized, and various methods such as a conjunctival advancement, a conjunctival patch graft, an amniotic membrane patch graft or an interpolated conjunctival pedicle flap have been described to cover the exposed tube.3-6 However, if these methods turn out unsuccessful or can not be utilized and the patient has implant-related intractable pain, inflammation, or endophthalmitis, the GDIs may have to be explanted from the eye. Explantation of a GDIs necessitates the repair of the fistula in the cornea and the sclera, which was previously occupied by the silicone tube. The corneoscleral fistula, if repaired with sutures alone, may lead to significant astigmatism or Received: December 27, 2007 Accepted: October 23, 2008 Reprint requests to Yong Yeon Kim, MD. Department of Ophthal- mology, Korea University Guro Hospital, 97 Guro-dong-gil, Guro-gu, Seoul 152-703, Korea. Tel: 82-2-818-6141, Fax: 82-2-857-8580, E-mail: yongykim@mail.korea.ac.kr * This study was presented at the 96th annual meeting of the Korean Ophthalmological Society in November, 2006 * The authors have no proprietary or commercial interest in any materials discussed in this article. 268 wound dehiscence. Sibayan et al.7 first reported the successful use of a processed pericardium to manage the corneoscleral fistula after explantation of GDIs. We describe four cases in which a pericardium (Tutoplast®, Innovative Ophthalmic Products, Costa Mesa, California, USA) plug was used to repair a corneoscleral fistula after Ahmed glaucoma valve (AGV New World Medical, Inc, Rancho Cucamonga, California, USA) explantation, and the postoperative outcomes from these cases which have been followed up for 12 months or longer. Case Repo rt Case 1: A 49-year-old man with neovascular glaucoma (NVG) in the right eye (RE), who had undergone phacoemulsification, posterior chamber lens (PCL) implantation, and AGV implantation, was referred to us. His intraocular pressure (IOP) (RE) was 40 mmHg despite medical therapy including dorzolamide 2% / timolol maleate ® 0.5% fixed combination (Cosopt , Merck & Co., Inc., Blue Bell, PA, USA), latanoprost 0.005% (Xalatan®, Pfizer, Inc., New York, NY, USA), and brimonidine purite 0.15% (Alphagan P® 0.15%; Allergan, Inc., Irvine, CA, USA). The AGV tube as well as its body was found exposed with complete melting of the patch graft and conjunctiva. The body of the valve was located close to the limbus (4 mm posterior to the limbus): in addition, this diabetic patient suffered from severe ocular pain (Fig. 1). Surgery was planned to remove the preexisting AGV and insert a new