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    Securing grafts without sutures

    Technique maintains static glaucoma drainage device placement, reduces risk of surgery complications

    Dr. SinghGlaucoma drainage devices aid in controlling IOP by redirecting aqueous from the anterior chamber to an external reservoir to regulate flow. They are typically used for patients who have failed previous surgeries or who have a high likelihood of failing procedures, such as trabeculectomy.1-7 While effective, they are traditionally anchored through the use of sutures, which is both time-intensive and may cause complications.

    Sutures are needed in several areas to secure the plate and tube to the sclera, to anchor the patch graft, and finally to close the wound.

    Typically, when suturing, I will use a 9-0 nylon, non-absorbable suture that remains in the eye post-surgery. While this does not generally cause issues it can theoretically cause bleeding, which could lead to fibrosis on the rare occasion that a blood vessel is punctured while placing the sutures.

     

    There is also the rare possibility that while the suture needle is puncturing through the sclera, the retina could be pierced. Other possible complications include substantial patient discomfort, and in some cases, absorbable sutures may cause inflammation and fibrosis scarring.8 Permanent non-absorbable sutures may cause tissue erosion, buttonholes, or tears.

    Posterior device placement (video)

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