Search

PURPOSE OF REVIEW The incentive for continued interest in aqueous devices in selected cases is mainly the result of the 5% incidence of late "blebitis" and endophthalmitis. The purpose of this review is to cover the most common complications that may arise and to offer strategies and techniques to avoid or rectify the complication. RECENT FINDINGS Complications of aqueous drainage devices are categorized in three stages: intraoperative, early postoperative ( 1 month). Intraoperative complications consist of anterior chamber entry, tube misdirection, and scleral perforation. Early postoperative complication includes hypotony and flat anterior chamber, choroidal effusions, and suprachoroidal hemorrhage. Late postoperative complication comprise tube migration, tube or plate extrusion, motility disturbance, and infection. SUMMARY Most complications seen in glaucoma drainage implants are self-resolving and rarely threaten visual outcome.

Purpose of review This paper summarizes the use of antifibrotic agents adjunctive to glaucoma surgery, reviews recently published studies that address current use of these antifibrotics, and reviews new methods of wound modulation. Recent findings The use of antifibrotic agents, namely, 5-fluorouracil and mitomycin C, in conjunction with glaucoma surgery has resulted in lower postoperative intraocular pressures after trabeculectomy or combined cataract and glaucoma surgery. Mixed results have been seen when these agents are used with glaucoma drainage device surgery. The use of antifibrotic agents has also created and increased complications. Therefore, methods of antifibrotic use have become more refined and modified for specific circumstances. Promising new wound modulation agents, such as CAT-152, are currently under study. Summary Antifibrotics are potent adjuncts to glaucoma surgery, but along with their beneficial use are risks that need to be considered. While we continue to look for more efficacious agents and methods to treat glaucoma, we must continue to modify techniques with the individual patient's best interest in mind.

To review the epidemiology, pathogenesis and management of uveitic glaucoma in the light of significant studies published during the review period (October 2002-2003).The visual prognosis of glaucoma secondary to certain types of uveitis, for example Juvenile Idopathic Arthritis, remains poor because of late presentation and a high rate of corticosteroid responsiveness. Production of Myocilin is intimately linked with outflow resistance and corticosteroid responsiveness. Although Myocilin gene expression is widespread in the eye, corticosteroid-induction is specific for trabecular meshwork. The hypotensive effect of some glaucoma medications such as Latanoprost and Brimonidine may be partially blocked by concurrent administration of NSAIDs, though the risk of redcrudescence of uveitis with Latanoprost appears to be much lower than initially feared. Use of Mitomycin C in uveitic trabeculectomy has not clearly translated into better long-term IOP control, though this may be due to an absence of prospective studies. Glaucoma drainage devices appear to be more successful in uveitic glaucoma than in other recalcitrant types.The management of uveitic glaucoma requires a careful balance between adequate anti-inflammatory therapy and appropriate intraocular pressure (IOP)-lowering to prevent long-term visual loss. In the foreseeable future, successful elucidation of the function of Myocilin is most likely to lead to improvements in the management of corticosteroid-induced and hence uveitic glaucoma.

Endophthalmitis post glaucoma drainage implant (GDI) surgery is rare, often associated with tube or plate exposure. We report a case of endophthalmitis following glaucoma shunt intraluminal stent exposure in a patient who underwent Baerveldt glaucoma implant surgery. Endophthalmitis following manipulation of intraluminal stents is a rare complication of GDIs but potentially vision threatening condition that needs to be carefully screened for and treated immediately. How to cite this article: Kwon HJ, Kerr NM, Ruddle JB, Ang GS. Endophthalmitis associated with Glaucoma Shunt Intraluminal Stent Exposure. J Curr Glaucoma Pract 2016;10(1):36-37.

The Ex-PRESS mini-glaucoma device is an alternative to traditional trabeculectomy. The device has been found to be safe, as efficacious and even superior to trabeculectomy in some aspects. For complex glaucomas, the Ex-PRESS should be considered as an alternative to glaucoma drainage implants. Winston Churchill once said, “Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.” Often in times of technological advance, progress requires a melding of tradition and innovation. Ophthalmology and glaucoma surgery are no different. Amidst a flood of minimally invasive glaucoma surgical advancements, filtration and shunt surgeries remain steadfast as definitive therapies for severe glaucoma. Trabeculectomy has remained the gold standard for glaucoma surgery; however, advances in surgical technique have even come to this decades-old procedure. The Ex-PRESS Mini-Glaucoma Device is now accepted in many circles as a modification of the trabeculectomy procedure available to many patients.

Glaucoma occurs with a relatively high frequency after Boston KPro (KPro) implantation. Disease course is often aggressive in nature and requires surgical intervention. Combined surgical techniques involving glaucoma drainage implant (GDI) surgery at the time of initial KPro implantation provide for successful postoperative results. The current chapter describes a technique involving combined GDI, KPro, and vitreoretinal surgeries. Posterior placement of the GDI tube allows for adequate postoperative contact lens fitting, decreasing the risk of conjunctival erosion and subsequent tube exposure. Patient candidates for this procedure must demonstrate medical and social stability as rigorous postoperative care is required to allow for proper monitoring and adjustment of medications. Coordination of care among expert ophthalmic subspecialists allows for optimal surgical outcome.

Glaucoma in aniridia usually develops during childhood, due to either open- or closed-angle mechanisms. In our study of Aniridia Foundation International (AFI) members, approximately half of the subjects developed glaucoma, with glaucoma diagnosis at average age 13.6 years and median age 8.5 years. The majority of patients were treated surgically for glaucoma. Average central corneal thickness is increased in aniridia, which may be a consideration for assessment of intraocular pressure. Although surgical procedures vary, clinicians often use glaucoma drainage implants to treat aniridic glaucoma. Regular monitoring during childhood, with prompt recognition of elevated intraocular pressure and effective management, may prevent vision loss due to glaucoma in aniridia.

Purpose To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt glaucoma drainage implant surgery. Design Noncomparative, interventional, retrospective, consecutive case series. Participants Thirty-three eyes of 33 patients. Intervention Combined phacoemulsification CE and Baerveldt glaucoma drainage implant (BGI) surgery at two tertiary care referral centers. Main outcome measures Visual acuity, intraocular pressure (IOP), and complications. Results The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0–46.9). The most common indication for combined CE and Baerveldt glaucoma drainage implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was ≥20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (± standard deviation) of 21 ± 7.3 mmHg preoperatively to 13.1 ± 3.5 mmHg at last follow-up visit ( P P Conclusions Combined CE and Baerveldt glaucoma drainage implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

PURPOSE To describe the outcomes of combining cyclophotocoagulation and tube-shunt glaucoma drainage implants, either sequentially or simultaneously, for the control of refractory glaucomas. PATIENTS AND METHODS A retrospective review was conducted of all patients that had been treated at our institute with both cyclophotocoagulation and a tube-shunt glaucoma drainage implant in the same eye between January 1996 and June 2000. Preoperative and postoperative intraocular pressure, number of glaucoma medications, vision, and complications data were collected for each eye. RESULTS A total of 10 eyes of 9 patients met the study criteria. The minimum follow-up period after the last surgery was 15 months. Intraocular pressures were reduced from 28.5 +/- 7.2 mm Hg preoperatively to 13.9 +/- 5.4 mm Hg postoperatively at 15 months (P < 0.000, n = 9). Medications were reduced from 2.7 +/- 1.2 preoperatively to 0.3 +/- 0.5 postoperatively at 15 months (P < 0.000, n = 9). Of the eight eyes with measurable Snellen acuity, postoperative vision decreased two or more lines in five eyes (63%). Complications included transient hypotony (one eye), transient serous choroidal detachment (two eyes), cystoid macular edema (two eyes), corneal edema (three eyes), and panuveitis with chronic hypotony and traction retinal detachment (one eye). CONCLUSIONS Combining cyclophotocoagulation with tube-shunt glaucoma drainage implants can effectively reduce intraocular pressure and number of glaucoma medications needed to achieve target intraocular pressure goals. Further study is needed to determine the safety of this combined approach compared with other available options to manage refractory glaucomas.

Pseudophakic patients that require surgical management of glaucoma have many of the same options as phakic patients. Considerations when performing incisional glaucoma surgery (trabeculectomy with adjunctive antimetabolites and glaucoma drainage device implantation) and laser glaucoma surgery (laser trabeculoplasty and laser cyclophotocoagulation) in pseudophakic patients are reviewed here. The decision to operate and the choice of surgical procedure must be individualized for each patient.

Glaucoma is a frequent reason of loss vision. It is usually caused by increased intraocular pressure leading to damage of optic nerve head. This work deals with the development of fibrous structure suitable for glaucoma drainage implants (GDI). Commercially produced metallic glaucoma implants are very effective in lowering intraocular pressure. However, these implants may cause adverse events such as damage to adjacent tissue, fibrosis, hypotony or many others [1]. The aim of this study is to reduce undesirable properties of currently produced drains and improve their properties by creating of the composite fibrous drain for achieve a normal intraocular pressure. Two types of electrospinning technologies were used for the production of very small tubular implants. First type was focused for production of outer part of tubular drain and the second type of electrospinning method made the inner part of shape follows the connections of both parts. Complete implant had a special properties suitable for drainage of fluid. Morphological parameters, liquid transport tests and in-vitro cell adhesion tests were detected.

Objective To compare the efficacy and safety of Ahmed glaucoma valve implantation (AGV) with trabeculectomy in the management of glaucoma patients. Methods A comprehensive literature search (PubMed, Embase, Google, and the Cochrane library) was performed, including a systematic review with meta-analysis of controlled clinical trials comparing AGV versus trabeculectomy. Efficacy estimates were the weighted mean differences (WMDs) for the percentage intraocular pressure reduction (IOPR %) from baseline to end-point, the reduction in glaucoma medications, and the odds ratios (ORs) for complete and qualified success rates. Safety estimates were the relative risks (RRs) for adverse events. All outcomes were reported with a 95% confidence interval (CI). Statistical analysis was performed using the RevMan 5.0 software. Results Six controlled clinical trials were included in this meta-analysis. There was no significant difference between the AGV and trabeculectomy in the IOPR% (WMD = -3.04, 95% CI: -8.36- 2.26; P = 0.26). The pooled ORs comparing AGV with trabeculectomy were 0.46 (0.22, 0.99) for the complete success rate (P = 0.05) and 0.97 (0.78–1.20) for the quantified success rate (P = 0.76). No significant difference in the reduction in glaucoma medicines was observed (WMD = 0.24; 95% CI: -0.27–0.76; P = 0.35). AGV was found to be associated with a significantly lower frequency of all adverse events (RR = 0.71; 95%CI: 1.14–0.97; p = 0.001) than trabeculectomy, while the most common complications did not differ significantly (all p> 0.05). Conclusion AGV was equivalent to trabeculectomy in reducing the IOP, the number of glaucoma medications, success rates, and rates of the most common complications. However, AGV was associated with a significantly lower frequency of overall adverse events.

The publication this month of “A Randomized Trial of a Schlemm’s Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open Angle Glaucoma” by Pfieffer et al (see page 1283), describing a promising new treatment for glaucoma, has stimulated this reflection of how glaucoma therapy has changed in the past quarter century, roughly the period that I have been in clinical practice. In 1990, we had not proven to others that glaucoma could be successfully treated, although we behaved as though it

Response to: RE: Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device

PURPOSE To determine whether a synthetic material, expanded polytetrafluoroethylene (E-PTFE), can be used successfully as a reinforcement material over the tubes of glaucoma drainage implants. METHODS Patches of E-PTFE were sutured over the tubes of Baerveldt glaucoma drains implanted in the eyes of New Zealand white rabbits. Two material thicknesses were tested: 0.5 mm in four eyes and 0.25 mm in five eyes. Rabbit donor scleral patches were used in five eyes as the control. Total ocular health and intraocular pressure were monitored every 2 weeks after the procedure. Six months after implantation, the eyes were harvested and analyzed histologically. RESULTS Two of the four eyes that received 0.5-mm thick E-PTFE patches showed some conjunctival melting over the anterior corners of the material close to the limbus. All five eyes that received 0.25-mm thick E-PTFE patches showed a healthy cellular wound healing response and no conjunctival melting. Cellular infiltration and collagen deposition in the E-PTFE materials showed integration of the patch material into the surrounding tissue. In the control eyes, marked thinning and resorption of the donor sclera immediately above the drainage tube was noted. CONCLUSION Thin (0.25 mm) E-PTFE patches were well tolerated in all rabbit eyes tested. Thin E-PTFE should be investigated further as a functional alternative to donor sclera for reinforcement in glaucoma drain surgery.

Glaucoma remains the leading cause of blindness after penetrating keratoplasty. Post-keratoplasty glaucoma was originally described in 1969, and its management is still controversial. Recent developments in management include newer classes of drugs, surgical procedures, such as trabeculectomy with mitomycin-C, implantation of glaucoma drainage devices, and cyclodestructive procedures with Nd: YAG and diode lasers. However, the risk of graft failure continues to be high with all surgical procedures.

Purpose To describe a novel approach to early postoperative intraocular pressure (IOP) control after glaucoma drainage device (GDD) implantation. Methods Two patients with elevated IOP after GDD implantation underwent internal GDD tube fenestration using a 30-gauge needle to perforate the GDD tube. Results IOP was lowered in each case by over 50% without complication. Conclusions Transanterior chamber internal GDD tube fenestration is a novel, straightforward approach to early IOP control after GDD implantation. This procedure adds to our armamentarium of methods for controlling IOP during the early postoperative period.

Anterior segment optical coherence tomography is a rapid, non-contact method of assessing anterior segment structures and has high reliability and repeatability. Three cases are presented to illustrate how this technology can be used in the assessment and management of a glaucoma drainage implant. Anterior segment optical coherence tomography provides high-resolution images of the glaucoma drainage implant to assess its position, patency, drainage, and the intraluminal stenting suture. This proved to be useful in the case of postoperative hypotony. The non-contact advantage is useful in pediatric patients.

Objective This study aimed to ascertain whether the Optimed, Krupin, and Ahmed drainage devices function as valves that vary resistance depending on flow conditions to maintain pressure within a desired range. Study Design Experimental study. Intervention The three devices and a control cannula were submerged in fluid and perfused with balanced salt solution using a computer-driven apparatus that continuously monitors flow (Q) and pressure (P). In one set of experiments, the flow rates were maintained at 2, 5, 10, 25, or 50 μl/min until steady-state pressures were achieved. In another set of experiments, the flow rate was increased linearly from 0 to 100 μl/min over 15 to 20 minutes. Main outcome measures The resistance of each implant was calculated from the first set of experiments by dividing the change in pressure (P) by the change in flow (Q) between successive perfusion rates. Flow-pressure curves were plotted from the experiments in which perfusion rate was increased linearly. Results Resistance remained relatively constant for the cannula (0.18–0.24 mmHg/μl/min), the Krupin (0.09–0.25 mmHg/μl/min), and the Optimed implants (0.04–0.08) throughout the tested flow rates. For the Ahmed device, conversely, resistance decreased proportionally (2.86–0.05 mmHg/μl/min) to the increase in flow. When flow rate was increased linearly from 0 to 100 μl/min, the Optimed and Krupin devices as well as the cannula generated a linear pressure response with a constant slope. The pressure in the two devices increased at a rate of 0.11 mmHg/μl compared to 0.23 mmHg/μl/min for the cannula. The flow-pressure curve for the Ahmed implant was distinct with a steep initial pressure rise and an essentially constant pressure of 12 mmHg thereafter. Conclusion The Optimed and Krupin devices displayed resistance and pressure responses to various flow conditions that were similar to those of a cannula or flow resistor. In these devices, resistance remained relatively stable and pressure increased linearly with flow. The Ahmed device, conversely, functioned as a valve that closely regulated pressure within a desired range by decreasing or increasing resistance as a function of flow.

Introduction In 2004, the authors had to remove two short Krupin valves because the Supramid tube of these valves implanted 13 years previously had migrated into the anterior chamber. Case report The first case was treated in April 2004, the second in November 2004. These valves had been implanted in January 1991 and August 1983 respectively; both because of insufficient, intense general and local medical treatments for vascular glaucoma: post-traumatic for one and neovascular glaucoma after central retinal vein occlusion for the other. Results In 2004 in each case, the authors performed the extraction, with Healon, of the Supramid tube that had migrated into the anterior chamber and the dissection of the previous scleral flap, which allowed them to uncover and extract the Silastic scleral tube whose split distal end continued to allow seepage of aqueous humour. The two lateral Supramid arms used to stitch the valve were also removed. The two valves were replaced with a Molteno glaucoma drainage implant. Follow-up was simple. Discussion Since February 1981, several Krupin valves, first short, then long, were placed in the Ophthalmic Ward of the Villeneuve St Georges Hospital in France. The authors discuss their structure and evolution. The design of these valves, at first made of two different materials (an intracameral Supramid tube followed by a intrascleral Silastic tube) evolved toward a draining tube made from the same material for its entire length, preventing the disconnection of the two tubes. A literature review retraces the history of the device and the modifications over time. Conclusion These old Krupin valves have stabilized the IOP for several years in numerous glaucoma patients who did not respond to intense medical treatments. Their dual-material concept was redesigned in favor of a single tube that could no longer become a mobile intraocular foreign body.

Purpose To report a case of spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). Methods An Ex-PRESS was implanted under the conjunctiva in a 76-year-old man with primary open-angle glaucoma. Results Two years after implantation, the Ex-PRESS extruded spontaneously. Despite this adverse event, there was no increase in intraocular pressure. Conclusions This is the first report of spontaneous extrusion of an Ex-PRESS device. Implanting the device under a scleral flap should be considered to avoid adverse events such as extrusion or conjunctival erosion.

Background: We report 2 cases in which ultrasound biomicroscopy (UBM) was used to diagnose Ahmed valve obstruction by the iris. Methods: Two patients underwent unilateral placement of Ahmed implants, one into the anterior chamber and the other into the ciliary sulcus. Results: Intraocular pressures increased in the early postoperative period. In each case, a clear view of the aqueous drainage tube was precluded. Occlusion of the end of the tube by iris tissue was demonstrated by UBM. An iridectomy over the tip of the tube instituted filtration in each case. Interpretation: UBM was instrumental in diagnosing the presence and cause of occlusion of aqueous drainage tubes.

Purpose To investigate the long-term surgical outcomes of the Baerveldt 250 mm 2 versus Baerveldt 350 mm 2 glaucoma drainage implants (GDIs) (Abbott Laboratories Inc., Abbott Park, IL) in the treatment of refractory glaucoma. Design Comparative case study. Participants A total of 89 consecutive eyes in 86 patients treated at Dean McGee Eye Institute between January 2006 and December 2008. Methods We retrospectively reviewed patient data from the following postoperative visits: 1 week, 1 month, 2 months, 3 months, 6 months, and every 3 months thereafter. Postoperative complications were also recorded. The mean follow-up time was 40 months (range, 2–78 months) for the Baerveldt 250 mm 2 group and 31 months (range, 3–75 months) for the Baerveldt 350 mm 2 group. Main Outcome Measures The primary outcome measure was surgical success. Secondary outcome measures included visual acuity (VA), intraocular pressure (IOP), and number of medications. Results There was no difference in surgical success ( P = 0.98). No significant differences were observed in VA measured using the logarithm of the minimum angle of resolution (logMAR) scale, IOP, and number of medications at the last visit ( P = 0.09, 0.23, and 0.82, respectively). Complication and failure rates were comparable ( P = 0.82 and 0.64, respectively). Conclusions With a mean follow-up of 40 and 31 months, no differences in surgical success, VA, IOP, number of medications at the last visit, and complication/failure rates were noted between the Baerveldt 250 mm 2 and 350 mm 2 GDIs, respectively. The size of the GDI may not be associated with surgical outcomes.

Tube-corneal touch occurring after Ahmed glaucoma valve (AGV) implantation is conventionally treated by tube cutting or tube transposition from the original pathway. However, in some cases, tube cutting is insufficient, and rearranging the pathway of the tube through a new sclera tunnel, ciliary sulcus, or pars plana is not feasible, as the conjunctiva and sclera covering the tube are difficult to be redissected. So, we propose a novel technique that repositions malpositioned AGV tube using scleral fixation and its successful applications in two patients with tube-corneal touch.(A) A scleral flap is made at the point for scleral fixation. (B) The anterior chamber is maintained using an anterior chamber maintainer. The incision is made immediately above the tube entering the anterior chamber and the tube end is flipped out using a Sinskey. (C) A double-armed 10/0 prolene straight needle is penetrated through the tube end. The leading needle enters the anterior chamber through the previously made incision and is pulled through the scleral flap. (D) The tube tip and the second needle of the double-armed 10/0 prolene straight needle also enter the anterior chamber through the previously made incision and the second needle is pulled through the scleral flap. The tube end is extended to be parallel to the cornea surface.Patients maintained good tube positioning without any serious complications during average of 15 months of follow-up after operation.We believe that our method is a simple and minimally invasive surgical method for treating AGV tube touching of the corneal endothelium. However, considering the limited number of cases studied and the short follow-up period, a larger group with a longer follow-up period is necessary.

To study the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with previous Ahmed glaucoma valve (AGV) implantation.Retrospective chart review of all patients who underwent DSAEK by a single surgeon in the setting of prior AGV implantation between December 2009 and September 2011 with at least 12 months follow-up. Preoperative and postoperative endothelial cell counts, visual acuity, intraocular pressure, and glaucoma medications were recorded.Eighteen eyes of 13 patients were included. The average endothelial cell count (cells/mm2) was 3087.7 (SD 390.8) preoperatively, 1974.3 (SD 646.0) at 6 months, 1831.7 (SD 851.2) at 12 months, and 1821.3 (SD 762.2) at 24 months. The average IOP (mm Hg) was 13.7 (SD 4.3) preoperatively, 15.1 (SD 5.0) at 6 months, 15.5 (SD 6.6) at 12 months, and 15.1 (SD 4.8) at 24 months. Average visual acuity (VA) preoperatively was 20/100 (logMAR 0.73, SD 0.27) and average best VA postoperatively was 20/60 (logMAR 0.5, SD 0.27). Nine of the 18 eyes (50%) had failed DSAEK grafts at 9.3 (SD 6.0) months. Six of these eyes had peripheral anterior synechiae (PAS) preoperatively, 3 had a history of uveitis, and 4 failures had multiple AGVs. Intraocular pressure control (21 mm Hg) was maintained without additional medications in 11 eyes (61%) and with additional medication in 4 eyes (22%). Intraocular pressure control was not maintained in 3 eyes (17%).Though challenging, DSAEK surgery can be successful in the setting of previous AGV implantation, with success rates comparable to those of penetrating keratoplasty in the same population. Higher failure rate of DSAEK with prior AGV appears to be associated with the presence of chronic angle closure glaucoma with 360-degree PAS with shallow chambers, the presence of multiple AGVs, and presence of uveitis.

* BACKGROUND AND OBJECTIVE: To assess the effect of topical cyclosporine on the function of filtering blebs and fibroblast proliferation after glaucoma drainage implant surgery in rabbits. * MATERIALS AND METHODS: Intraocular pressure, flow resistance through the implant capsule, and fibroblast density in the capsule were compared between 12 eyes that received implant surgery only (group A) and 1 1 eyes treated with topical 2% cyclosporine twice a day for 2 weeks after implant surgery (group B). * RESULTS: There were significantly larger decreases in intraocular pressure at 1, 2, 4, and 8 weeks postoperatively in group B than in group A (n = 12, P < .05). Flow resistance was significantly lower in group B than in group A (n = 5, P < .05) at 8 weeks postoperatively. Fibroblast density was not significantly different between the two groups (n = 3, P> .05). * CONCLUSION: These results suggest that topical 2% cyclosporine may enhance the effectiveness of glaucoma drainage implant surgery. [Ophthalmic Surg Lasers 1996;27:452-458.]

To evaluate the long-term outcomes of a surgical technique using a sutureless bovine pericardial patch graft for the implantation of an Ahmed glaucoma valve (AGV). This was a pilot study on patients with primary open-angle glaucoma refractory to repeated surgical filtering procedures. All patients underwent AGV implant technique using a sutureless bovine pericardial patch graft. The pericardial membrane was cut using an ordinary corneal trephine with a diameter of 9.0 or 10.0 mm. The anterior part of the tube was covered with the graft and kept in place with fibrin glue. Subsequently, the cap was stitched all around the tube and the dissected conjunctiva was laid over it. Intraocular pressure (IOP) and complications were evaluated 1 week and 1, 3, 6, 12, and 24 months after surgery. The procedure was used to treat 20 eyes of 20 consecutive patients (12 men and 8 women: mean age [SD] 64.8 [7.8] years). Mean IOP was 28.1 mm Hg (SD 4.9) at baseline and decreased to 14.9 mm Hg (SD 1.5) 24 months after surgery (p0.001). The overall mean number of topical medications was 3.1 (SD 0.5) at baseline and decreased to 1.4 (SD 0.8) after 24 months (p0.001). During follow-up, there was no conjunctival erosion, thinning of pericardial patch graft over the tube, or tube exposure; no signs of endophthalmitis were recorded. The results suggest that the sutureless technique using a bovine pericardial graft patch is a safe and rapid procedure for AGV implantation.