-: In this video, we present a Paul glaucoma implant
operation in a case of glaucoma with mucopolysaccharidoses.
Mucopolysaccharidoses are a group of disorders due
to accumulation of glycosaminoglycans in tissues.
Prevalence of glaucoma is nearly 10%.
Although different surgical options
with different surgical success rates were reported up
to now, to our knowledge
there is no case report presenting Paul implant in
mucopolysaccharidosis.
Thirteen-year-old boy referred us
for bilateral increased IOP and corneal clouding.
Patient was diagnosed as mucopolysaccharidosis type VI.
Visual acuities were very low in both eyes due
to high IOP measurements and glaucomatous optic atrophy.
We recommend our young patient Paul glaucoma implant.
The globe is deviated by the help
of corneal 6-0 Vicryl suture.
Limbal-based conjunctival incision done.
0.2 milligrams per milliliter
subconjunctival mitomycin C
injection is applied to surgical area.
Tenon is dissected carefully
for double-Tenon technique described by Tom Chelik
et al.
Episcleral vessels are cauterized.
7-0 Prolene is sutured parallel nearly 10 millimeter
to limbus for Paul implant plate fixation
Viscoelastic is injected into the tube ostium on plate
to easily propagate the 6-0 Prolene suture for occlusion.
Plate of the implant is inserted under
the rectus muscle. Plate is fixated
to the sclera.
Steel-tip 26-gauge needle is used to notify
the entrance place for anterior chamber.
Tube is inserted into the anterior chamber.
Tenon is closed by double-Tenon technique.
Conjunctiva is sutured continuously with 8-0 Vicryl
and the operation is finalized.
Patient's IOP was under 20 mm Hg in the last
postoperative third month exam.