Repair Leaking Trabeculectomy
Robert Schertzer, MD, shows the surgical management of a patient whose trabeculectomy glaucoma filtering bleb has become so thin and distended that it is painful, reducing her vision from hypotony, and leaking resulting in recurrent infections.
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Comments (6)
I guess it wasnt the flap what was exciced, just the outer wall of the cist.
nice video.we can use amniotic membrane to close the leak ,my question why did you excise the flap?
We can use the membrane Alaminoc to close the hole over the solid eye, where we can prevent excessive leakage and lack of cyst formation of a new welded and then sewing the conjunctiva in the same way.....thanx >>>D.Michel
yes-how does one mobilize conj to cover the defect? can one make a relaxing incision high in the fornix, or will that cause a leak?
Thank you for this nice video showing how to manage a very difficult problem!! I do find placing a scleral patch graft over the hole necessary and suturing it down with an overlying compression suture to avoid hypotony (this suture can be cut with the laser if IOP lowering necessary). Also, critical to success in these cases is having cooperative conj to bring forward which appeared to be apparent in this video. This is not always the case and the conj can sometimes be very difficult to bring forward making closure much more difficult.
Nice video showing how to manage a very difficult problem! I have had similar cases where is was necessary to place a patch graft over the gaping hole with an overlying compression suture (which could be cut later if IOP was high). The key with these cases is having posterior conjunctiva to bring forward without significant tension. The conj in this case was fortunately very cooperative but this is not always the case