title: Tenon advancement and duplication technique to prevent postoperative Ahmed valve tube exposure in patients with refractory glaucoma.
abstract: OBJECTIVE
  To present and compare the long-term results of Dr. Tamcelik's previously described technique of Tenon advancement and duplication with the conventional Ahmed glaucoma valve (AGV) implantation technique in patients with refractory glaucoma.
  
  
  METHODS
  This study was a multicenter, retrospective case series that included 303 eyes of 276 patients with refractory glaucoma who underwent glaucoma valve implantation surgery. The patients were divided into three groups according to the surgical technique applied and the outcomes compared. In group 1, 96 eyes of 86 patients underwent AGV implant surgery without patch graft; in group 2, 78 eyes of 72 patients underwent AGV implant surgery with donor scleral patch; in group 3, 129 eyes of 118 patients underwent Ahmed valve implant surgery with "combined short scleral tunnel with Tenon advancement and duplication technique". The endpoint assessed was tube exposure through the conjunctiva.
  
  
  RESULTS
  In group 1, conjunctival tube exposure was seen in 11 eyes (12.9 %) after a mean 9.2 ± 3.7 years of follow-up. In group 2, conjunctival tube exposure was seen in six eyes (2.2 %) after a mean 8.9 ± 3.3 years of follow-up. In group 3, there was no conjunctival exposure after a mean 7.8 ± 2.8 years of follow-up. The difference between the groups was statistically significant. (P = 0.0001, Chi-square test).
  
  
  CONCLUSIONS
  This novel surgical technique combining a short scleral tunnel with Tenon advancement and duplication was found to be effective and safe to prevent conjunctival tube exposure after AGV implantation surgery in patients with refractory glaucoma.
authors.affiliation: Ophthalmology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey. nevbahartamcelik@gmail.com
authors.forename: Nevbahar
authors.initials: N
authors.lastname: Tamcelik
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozkok
authors.forename: Ahmet Murat
authors.initials: AM
authors.lastname: Sarıcı
authors.forename: Eray
authors.initials: E
authors.lastname: Atalay
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yetik
authors.forename: Kivanc
authors.initials: K
authors.lastname: Gungor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D058475:Tenon Capsule / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult