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Soosan Jacob FRCS
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Stab Incision glaucoma surgery (SIGS) is a technique for guarded filtration surgery described by Soosan Jacob in the beginning of 2013. As of March 2015, there are more than 250 cases performed by the Dr. Agarwal's Eye Hospital group in India and more than 120 performed by the group in Africa. It has also been adopted by various doctors in USA, Europe, Asia and the Middle East.
This video shows Step by Step the technique for performing a SIGS with latest modifications. It would be useful for someone starting out with SIGS to view it.
Pre-op MMC of 0.2 mL of 0.02% MMC is given in the sub-conjunctival space about 6 mm from the limbus 20 minutes prior to surgery. This prevents the conjunctival lips from scarring down. This is easy and safe and avoids need for the conjunctival incision to be opened excessively and is the protocol that Dr. Jacob follows in all cases now. The use of MMC pre-operatively is an accepted technique in conventional trabeculectomy. It is given tangential to limbus 6mm above the superior limbus at the site of the incision. The needle is introduced from temporal conjunctiva parallel to the limbus till the site of intended surgery is reached and then injected. This avoids buttonholing at the site of bleb.
Posted: 5/13/2015
Soosan Jacob FRCS
Stab Incision glaucoma surgery (SIGS) is a technique for guarded filtration surgery described by Soosan Jacob in the beginning of 2013. As of March 2015, there are more than 250 cases performed by the Dr. Agarwal's Eye Hospital group in India and more than 120 performed by the group in Africa. It has also been adopted by various doctors in USA, Europe, Asia and the Middle East.
This video shows Step by Step the technique for performing a SIGS with latest modifications. It would be useful for someone starting out with SIGS to view it.
Pre-op MMC of 0.2 mL of 0.02% MMC is given in the sub-conjunctival space about 6 mm from the limbus 20 minutes prior to surgery. This prevents the conjunctival lips from scarring down. This is easy and safe and avoids need for the conjunctival incision to be opened excessively and is the protocol that Dr. Jacob follows in all cases now. The use of MMC pre-operatively is an accepted technique in conventional trabeculectomy. It is given tangential to limbus 6mm above the superior limbus at the site of the incision. The needle is introduced from temporal conjunctiva parallel to the limbus till the site of intended surgery is reached and then injected. This avoids buttonholing at the site of bleb.
Posted: 5/13/2015
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Just Now
Soosan Jacob
10 years ago
Hi Rafa, I now take a punch that goes more posteriorly and hence is closer to the iris base and therefore can get plugged by the iris. Hence, a PI in all cases now. It's easy to do a PI if your assistant helps by retracting the conjunctiva once you have held the iris. Use a curved Vannas as that gives a better, more basal PI. Also, make sure you grab the iris close to the base and also that it is held in line with the ostium and not to either side. Hope this helps.
Rafael Castañeda Diez
10 years ago
Why in these case you decide to perform an iridotomy?