Faculty Bibliography

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.