© 2010 Wichtig Editore - 1120-6721 Eur J Ophthalmol ( 2010 ; : 3) 546-551 20 546 ORIGINAL ARTICLE INTRODUCTION The Ahmed glaucoma valve (AGV) (New World Medical, Ran- cho Cucamonga, LA) is rapidly growing in popularity world- wide and has become a significant component of the surgical routine program for refractory glaucoma cases (1-3). Although these innovative valve systems have demon- strated several advantages on nonvalved drainage im- plants (GDIs), they still show some complications, such as diplopia, tube erosion, and implant extrusion, related to the foreign body implant reaction (4, 5). The aim of this prospective study was to evaluate the safe- ty and efficacy of a sutureless human sclera donor patch graft in the prevention of conjunctival erosion caused by the glaucoma drainage implant tube. MATERIALS AND METHODS Study design A prospective pilot study was performed. Fifteen eyes of 15 consecutive patients not responsive to medical and Sutureless human sclera donor patch graft for Ahmed glaucoma valve Lucio Zeppa 1 , Mario R. Romano 2 , Luigi Capasso 3 , Achille Tortori 3 , Mara A. Majorana 1 , Ciro Costagliola 2 1 Unità Operativa di Oculistica, Presidio Ospedaliero Giuseppe Moscati, Avellino 2 Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso 3 Unità Operativa di Oculistica, Presidio Ospedaliero dei Pellegrini, Napoli - Italy PURPOSE. To report the safety and effectiveness of a sutureless human sclera donor patch graft cover- ing the subconjunctival portion of glaucoma drainage implant tube to prevent its erosion throughout the overlying conjunctiva. METHODS. This was a prospective pilot study. Fifteen eyes of 15 consecutive patients not responsive to medical and to not-implant surgical glaucoma treatment underwent Ahmed glaucoma valve (AGV) implant surgery with sutureless human sclera donor patch graft. The surgical procedure included AVG implant placed 8 mm behind the corneal limbus and fixed to the sclera with two 9-0 black nylon su- tures. The tube was passed through the scleral tunnel, parallel to the corneal limbus, and shortened at the desired length. The anterior part of the tube was covered with human donor scleral graft and kept in place with fibrin glue (Tissue Coll ® ) under the conjunctiva. Examinations were scheduled at baseline and then at 1 week and 1, 3, 6, and 12 months after surgery. RESULTS. At 12-month follow-up, the best-corrected visual acuity did not significantly improve from baseline 0.78±1.2 logMAR, whereas mean intraocular pressure significantly decreased from preop- erative values of 29.8 (SD 8.4) mmHg. In all cases, the scleral patch was found in place at each check during the follow-up period. No conjunctival erosion over the AGV tube nor sign of endophthalmitis was recorded at any time during the follow-up period. CONCLUSIONS. AVG implant surgery with sutureless human sclera donor patch graft represents an effec- tive and relatively safe surgical procedure for complicated glaucomas, avoiding conjunctival erosions over the AGV tube. (Eur J Ophthalmol 2010; 20: 546-51) KEY WORDS. Ahmed glaucoma valve, Patch graft, Refractory glaucoma, Sclera donor Accepted: November 2, 2009