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    Securing grafts without sutures

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

     

    Applying the sealant

    During the procedure, I place the plate about 11 to 12 mm behind the limbus and then apply the sealant over the suture islet holes with the included applicator. It takes only seconds to set and then I firmly tug on the plate to test its stability and ensure the sealant is still over the suture holes.

    After the tube is in place, I dry the sclera and apply sealant to the area in order to secure the patch graft over the tube. It can be difficult to keep the area dry.

    Cellulose sponges (WECK-CEL, Beaver-Vistec International) can be used to assist in drying the conjunctiva and sclera and in absorbing any blood from vessels that may be leaking or anesthetic that might have been injected.

    I also position the sponges to the sides of where the sealant will be placed to keep the conjunctiva tented above so it does not touch the sclera while I dry any residual amounts of fluid that might present. Those will remain in position while the sealant is applied. Then, I place the sealant on the sclera and tutoplast or amniotic membrane and close the wound.

    The biggest concern when transitioning from a permanent suture to an absorbable sealant seems to be the possibility of the plate shifting. If the conjunctiva is especially thin, any movement may cause erosion.

    While there is no way to measure how long the sealant lasts once it is under the conjunctiva, it typically lasts between 1 and 3 days in other applications. However, it is possible to determine within seconds of application if the sealant is holding and I have not had any instances of migration.

    I have found the use of a sealant to comfortably, quickly, and more efficiently secure a plate. The ability to secure these plates in an ideal location without the need for sutures is significantly advantageous to both surgeon and patient. 

     

    Inder Paul Singh, MD, is president of The Eye Centers of Racine and Kenosha in Wisconsin. Dr. Singh has financial interest with Ocular Therapeutix. He can be reached at [email protected].

     

    References

    1Brown RD, Cairns JE. Experience with the Molteno long tube implant. Trans Ophthalmol Soc UK 1983;103:297-312.

    2Mermoud A, Salmon JF, Alexander P, et al. Molteno tube implantation for neovascular glaucoma: long term results and factors influencing out¬come. Ophthalmology 1993;100:897-902.

    3Hill RA, Nguyen QH, Baerveldt G, et al. Trabeculectomy and Molteno implantation for glaucomas associated with uveitis. Ophthalmology 1993;100:903-908.

    4Sidoti PA, Dunphy TR, Baerveldt G, et al. Experience with the Baerveldt glaucoma implant in treating neovascular glaucoma. Ophthalmology 1995;102:1107-1118.

    5Da Mata A, Burk SE, Netland PA, et al. Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Opthalmology 1999;106:2168-2172.

    6Ceballos EM, Parrish RK, Schiffman JC. Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma. Ophthalmology 2002;109:2256-2260.

    7Papadaki TG, Zacharopoulos IP, Pasquale LR, et al. Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol 2007;144:62-69.

     8Biedner B, Rosenthal G. Conjunctival closure in strabismus surgery: vicryl versus fibrin glue. Ophthalmic Surg Lasers 1996 Nov;27(11):967.

    9 Masket S, Hovanesian J, et al.  Hydrogel sealant versus sutures to prevent fluid egress after cataract surgery. J Cataract Refract Surg 2014; 40:2057–2066.

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