title: Use of Autologous Scleral Graft in Ahmed Glaucoma Valve Surgery.
abstract: OBJECTIVE
  To compare the efficacy of an autoscleral free-flap graft versus an autoscleral rotational flap graft in Ahmed glaucoma valve (AGV) surgery.
  
  
  METHODS
  Medical records (2005 to 2012) of 51 consecutive patients (51 eyes) who underwent AGV surgery with the use of either an autoscleral free-flap graft or an autoscleral rotational flap graft to cover the external tube at the limbus were retrieved for review. The main outcome measure was the incidence of tube exposure associated with each surgical approach.
  
  
  RESULTS
  Twenty-seven consecutive patients (27 eyes) received a free-flap graft and 24 consecutive patients (24 eyes) received a rotational flap graft. The mean follow-up time was 55.6 ± 18.3 months for the former and 24.2± 5 .0 months for the latter (P<0.0001). Two patients in the free-flap group (8.9%) developed tube exposure at 24 and 55 months postoperatively compared with none of the patients in the rotational flap group. Graft thinning without evidence of conjunctival erosion was observed in 15 patients (55%) in the free-flap group and in 7 patients (29.1%) in the rotational flap group.
  
  
  CONCLUSIONS
  The use of an autoscleral rotational flap graft is an efficacious technique for primary tube patch grafting in routine AGV surgery, and yielded better results than an autoscleral free-flap graft. Its main advantages over donor graft material are availability and lower cost.
authors.affiliation: Departments of *Ophthalmology †Community Medicine and Epidemiology, Carmel Medical Center, affiliated to the Rapaport Faculty of Medicine, The Technion, Haifa, Israel.
authors.forename: Alvit
authors.initials: A
authors.lastname: Wolf
authors.forename: Yair
authors.initials: Y
authors.lastname: Hod
authors.forename: Gila
authors.initials: G
authors.lastname: Buckman
authors.forename: Nili
authors.initials: N
authors.lastname: Stein
authors.forename: Orna
authors.initials: O
authors.lastname: Geyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D005260:Female; D058752:Free Tissue Flaps; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012590:Sclera / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult