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Step by Step SIGS with Pre-Op MMC with Phacoemulsification

  Channels: Glaucoma | Posted 5/13/2015

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.

Glaucoma • Mitomycin C, MMC • Phacoemulsification • Stab Incisional Glaucoma Surgery (SIGS)


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