Faculty Bibliography

PURPOSE/OBJECTIVE:The suprachoroidal space (SCS) has been a successful target to lower intraocular pressure (IOP) in glaucoma patients. We present the results of 4 patients who underwent a novel glaucoma surgical procedure to lower IOP: Intrascleral Ciliary Sulcus-Suprachoroidal Microtube. METHODS:A sterile medical grade silicone microtube (Tube extender, New World Medical) was surgically placed to drain aqueous from the posterior chamber ciliary sulcus of the eye to the SCS. The internal diameter of the tube was 300 um and the length varied from 8-10mm. After informed consent was obtained and witnessed, this procedure was performed in glaucoma patients with pseudophakia. The tube was placed intrasclerally beneath an inferotemporal sclera flap (50% thickness approximately 4mm x 4mm). The anterior end of the tube was inserted into the ciliary sulcus approximately 2mm from the limbus and the posterior end was placed into the SCS approximately 4mm from the limbus. The microtube was sutured to the sclera with a 10-0 nylon suture. 8-0 vicryl sutures were used to close the sclera flap and the conjunctiva inferotemporally. RESULTS:All 4 patients had lower IOP. The average reduction of IOP was 36% at 3 months. The amount of glaucoma medications per patient at 3 months dropped from an average of 3 to 0.25. The risks are similar to traditional glaucoma incisional surgery. CONCLUSION/CONCLUSIONS:This new technique of Intrascleral Ciliary Sulcus-Suprachoroidal Microtube in all four patients with mild, moderate, and advanced glaucoma demonstrated a significant lowering of IOP and a decrease in the number of medications. Further research is required to assess long term efficacy and safety.

PURPOSE/OBJECTIVE:We describe a novel technique comprising the use of trypan blue to confirm aqueous outflow to collector channels and aqueous veins after goniotomy with the Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA). Intraocular dyes have been safely used during ophthalmic surgery to evaluate the patency of the trabecular meshwork and collector channels. Further, trypan blue has been safely used to stain the anterior capsule of the lens in cataract surgery, to enhance visualization for capsulorhexis; similarly, trypan blue has been safely used to stain the trabecular meshwork for enhanced visualization during glaucoma angle surgery. Channelography enables evaluation of the collector channels during canaloplasty with fluorescein dye; episcleral fluid wave enables evaluation of the intraoperative structural patency of the conventional outflow system, from the anterior chamber to the episcleral and conjunctival distal collectors after Trabectome goniotomy (NeoMedix Corporation, Tustin, CA). PATIENTS AND METHODS/METHODS:We evaluated 4 cases of glaucoma patients who underwent goniotomy with the Kahook Dual Blade to observe whether trypan blue could identify the patency of Schlemm's canal and aqueous egress to episcleral and intrascleral veins. RESULTS:We successfully confirmed the outflow pathway via Schlemm's canal and collector channels with trypan blue in 3 of the 4 cases. CONCLUSIONS:We conclude that trypan blue can be used safely to confirm both aqueous outflow and the patency of Schlemm's canal and aqueous veins during canalicular glaucoma surgery.

PURPOSE/OBJECTIVE:To describe a new surgical technique for refractory glaucoma with failed XEN gel stent surgery with insertion of the Baerveldt implant. SURGICAL TECHNIQUE/METHODS:In a patient with a failed XEN gel stent, a gentle conjunctival dissection was performed to expose the XEN and remove subconjunctival obstruction thus restoring patency and flow. A Baerveldt 250 implant was inserted in the superonasal quadrant above the extraocular muscles and sutured to the sclera. The Baerveldt tube was correctly positioned to accept insertion of the present XEN gel stent. The double lumen was sutured to secure the position. Two corneal patches were sutured over the tube to prevent exposure. The usual conjunctival suturing closure was performed. CONCLUSION/CONCLUSIONS:This technique is simple and restores lowering of intraocular pressure in patient with failed XEN and potentially increases the safety of refractory glaucoma surgeries in these patients.