EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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91 EW GLAUCOMA October 2014 Purpose: To evaluate a new tech- nique for single stab trabeculectomy (SST) working on a compromised tunnel principle. Methods: Patients requiring glaucoma filtering surge y with or without phaco were included. A transconjunctival single stab entry through lamellar sclera and cornea into the AC was created without dissecting conjunctiva. If combined with phaco, cataract extraction and IOL implantation were carried out at this stage. The internal lip of the tunnel thus obtained was punched with a Kelly Descemet's punch. A PI was done in select cases. Filtration was verified and conjunctiva was closed with a continuous 10-0 nylon suture. Results: 20 patients underwent either single stab trab with or without phaco. 1 case experienced a premature entry and was convert- ed into conventional trab. Surgery was uneventful in all other cases. Postoperative period was uneventful in all cases except one patient who developed a steroid induced glauco- ma that responded to withdrawal of steroids. anterior chamber was least using an automated injector. Dr. Ansari: Acute primary angle clo- sure requires immediate intervention. Argon laser peripheral iridoplasty has been suggested as both first-line and second-line treatment for acute primary angle closure. Dr. Sng and colleagues are to be applauded for their meticu- lous study of anterior chamber angle anatomy in acute primary angle closure before and after treatment with either medical therapy or iridoplasty. What makes this report stand out is that the authors demonstrate in a highly quan- tified way that the anterior chamber angle is indeed widened by argon laser iridoplasty. Furthermore, this increase in angle dimensions is significantly greater in patients undergoing irido- plasty than in those receiving medical therapy. This study adds to the growing body of evidence that iridoplasty is an excellent treatment modality for acute primary angle closure and should be in our armamentarium for this devastating problem. Single stab trabeculectomy: new technique for glaucoma filtering surge y for minimizing scar induction and bleb failure Kala Satish, MD, and colleagues stromal hydration, trypan blue 0.0125% was applied over the conjunctival surface and ingress compared. Architectural features of CCIs were evaluated using anterior segment OCT (AS-OCT) on postop- erative day 1, 1 week, and 1 month. Results: Ongoing study results of 60 eyes were presented, and results will be updated. Incision enlarge- ment from the end of phacoemul- sification to IOL implantation was: Group I (n=19): 0.07+0.05, Group II (n=18): 0.16+0.05, Group III (n=23): 0.22+0.04; difference being statisti- cally significant P=0.03). Incision enlargement was greatest with the Monarch III injector, followed by Royale and Autosert. Trypan blue concentration into anterior chamber was (log units): Group I=1.97+0.45, Group II=1.78+0.48, Group III=2.16+0.38; difference not statistically significant P=0.48). No difference in Descemet's detach- ment, incision gaping, and loss of coaptation between groups at any follow-up (P>0.05). Conclusion: All injectors allowed smooth IOL implantation through a 2.2 mm incision. However, incision enlargement and trypan blue ingress from the extraocular surface into the Best in glaucoma Conclusion: Glaucoma filtering su - gery can be simpler, more effective, less fibrogenic by a simple vari - tion in the established technique of trabeculectomy. Compromised tunnel gives effective filtration and good lowering of IOP. Absence of conjunctival dissection induces less scarring, less failure and leaves more virgin conjunctiva. Early results are promising. Larger study is underway. Dr. Ansari: This study by Dr. Satish and colleagues proposes a fascinating stab-incision technique for performing filtration surge y that, in the hands of the authors, is both efficient and successful. In the current environment where MIGS is appropriately getting extensive attention, this paper high- lights that there is and will continue to be a need for glaucoma filtering surge y and that innovation in techniques for filtration surge y must continue. EW Editors' note: Dr. Ansari has financial interests with Ivantis (Irvine, Calif.), Alcon (Fort Worth, Texas), and Allergan (Irvine, Calif.). Contact information Ansari: hansari@eyeboston.com View Dr. Ansari's presentation at Clinical.EWrePlay.org.