• Low Profile/Multi-directional strength
• Immunologically safe
• Activates in simple saline within minutes
• Five year shelf life
• Single use, sterile packaging

During the past 30 years, over 1 million Tutoplast® Bioimplants have been surgically implanted without a single documented case of disease transmission.

PROBLEM

Hypotony/Overfiltration with a Leaking Bleb(Trabeculectomy)

SOLUTION

Use of Pericardium Patch Graft for the Treatment of Hypotony/Bleb Revision

• Excise the shallow bleb via a fornix-based incision.
• Free atrophic conjunctival tissues from adherence to the cornea. The incision is extended from the nasal and temporal portion of the bleb to mobilize the conjunctiva anteriorly.
• Excise devitalized conjunctival tissue; maintain as much vital tissue as possible for subsequent coverage of pericardial graft.
• Employ a cautery to: a) quell excessive bleeding; b) create a scleral “groove” anterior to the leak at the corneal limbus to assist the adherence of the subsequent pericardium graft.
  
• Identify episcleral fistula by applying topical fluorescein. A single interrupted suture may be employed to tamponade anterior leakage.
  
• The Tutoplast® Pericardium is then adequately sized to cover the scleral opening. The aim is to restrict aqueous flow anteriorly but allow for flow posteriorly. This promotes bleb formation and pressure control immediately post-operatively.
• Suture the pericardium into place with two 9.0 or 10.0 nylon sutures, tented nasally and temporally to facilitate flow.
  
• The anterior edges of the pericardium should be trimmed and thinned to prevent conjunctival "bunching” or dellen effect.
  
• Test flow the site through a previously made paracentesis to identify proper fistulization.
  
• Conjunctiva is advanced anteriorly and secured with conjunctiva-sclera-conjunctiva bites. See graphic. Ensuring water-tight closure is crucial.
  NOTE: If the remaining, limbal-based conjunctiva resists advancement: a) a relaxing incision can be made 8-10 mm behind the limbus; or b) an inferior conjunctival autograft may be necessary to cover the pericardium patch.
  
• The chamber is once again deepened and fluorescein is applied to confirm a secure seal.