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C. Rogers, R. Krishnan, A. Choudhary, P. K. Wishart; Bovine Pericardium (Tutopatch) Used to Cover Ahmed Valve Tubing Associated With Severe Conjunctival Inflammatory Melt. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4184.
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Tube erosion is a problem and a risk factor for endophthalmitis. Scleral rotation flaps are not always possible due to previous surgery or scleral thinning and donor sclera can be a difficult medium with which to work. Tutopatch is readily available and easy to use. This study aimed to determine whether Tutopatch had similar complication rates to sclera and hence was a suitable alternative.
This is a consecutive case series of Ahmed Valve procedures performed in one unit between November 2005 and June 2007. 21 scleral rotation flaps were followed prospectively and adverse effects identified. Donor allografts and Tutopatch cases performed during this time by the same surgical team were identified and analysed retrospectively. Fisher's exact tests were used to compare the data.
5 /15 Tutopatch grafts had severe conjuntival inflammatory melt. 1 /21 rotation flaps had tube exposure. There were no complications with scleral allografts (N=25). There was a significant difference between the Tutopatch and scleral allografts (p=0.005). The difference between Tutopatch and rotation flaps approached significance (p=0.063). There was no statistical difference between scleral allografts and rotation flaps.
Both donor scleral allografts and scleral rotation flaps were well tolerated. However, donor sclera can be difficult to use and scleral rotation flaps are not always possible. Tutopatch is easy to use and always available but was associated with severe conjunctival inflammatory melt in 33% of cases. Therefore we recommend that bovine pericardium should not be used to cover the drainage tube of Ahmed Valves.
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