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Stab Incision Glaucoma Surgery or SIGS

Soosan Jacob FRCS

SIGS or Stab Incision Glaucoma Surgery is a new technique that I have described for guarded filtration surgery. This video won the runner up award in the recently concluded ASCRS film festival 2014 and free paper on SIGS also won best paper award in the Glaucoma category at the ASCRS 2014 annual conference. SIGS acts by making a single step entry into the anterior chamber via a sclero-corneal tunnel using a 2.8 mm keratome. The tunnel starts 2 mm from the limbus on the scleral side and 1 mm into clear cornea. The SIGS tunnel is then intentionally compromised by punching the posterior corneal lip with a 1mm Kelly's Descemet's punch. This punch extends backwards in the clear cornea up to the limbus as seen from the microscope. This surgery has advantages of only a single 2.8 mm cut in the conjunctiva which is also well separated from the scleral tunnel, almost complete elimination of subconjunctival dissection and a greatly reduced risk of failure secondary to sub-conjunctival scarring which is so common in conventional trabeculectomy and all other related procedures which involve creating a limbal or fornix based conjunctival flap. Surgery is easier, faster.and less traumatic and flap related complications are minimized. The amount of virgin conjunctiva is maximized and the bleb is created not by scissor dissection but by the more physiological hydrostatic expansion of sub-conjunctival spaces and drainage channels. A posteriorly directed flow is obtained. We have had excellent results with this procedure with a high safety profile. A PI is indicated only in cases with angle closure, PAS, shallow AC and intraoperative peaking of iris into the ostium. As it is not routinely required in open angle glaucoma, post-operative inflammation is greatly minimized. The surgery also avoids need for expensive devices that the recent MIGS procedures are associated with. Additional instrumentation that is required only includes a 2.8 mm bevel up keratome and a Kelly's Descemet's punch.

For additional SIGS videos by Soosan Jacob, FRCS, watch:

SIGS Releasable Suture
Step by Step SIGS with Pre-Op MMC with Phacoemulsification

Posted: 5/16/2014