Issue: July 2012
May 30, 2012
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Modified scleral flap technique yields reduced rate of postoperative tube exposure

Issue: July 2012
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MILAN, Italy — Using an autologous scleral flap rather than foreign graft tissue to cover the tubes of glaucoma drainage devices significantly lowers the rate of postoperative tube exposure, according to one surgeon speaking at the annual joint meeting of OSN and the Italian Society of Ophthalmology.

“A conjunctival peritomy is performed to expose the area, and the implant is inserted and sutured in place,” Brian E. Flowers, MD, said. “At this point, a scleral flap is performed, and a belt loop is created along the unhinged side of it. An incision is performed under the flap, near the hinge, using a 23-gauge needle. The tube is passed under the belt loop and then pushed through the incision into the anterior chamber. The flap is then closed and sutured and covered with the conjunctiva.”

A retrospective review of 189 eyes showed that tube exposure occurred in 9.5% of glaucoma drainage device procedures in which a patch graft was used vs. 0.7% of procedures in which the tube was covered with the patient’s own scleral flap.

“This technique is immune-friendly, as the eye will not erode its own conjunctiva,” Dr. Flowers said.

  • Disclosure: Dr. Flowers has no relevant financial disclosures.