OCT 24, 2017
Glaucoma, Surgical Management
Dr. Elena Bitrian demonstrates her technique for bleb revision for hypotony:
- Use Westcott scissors to sharply dissect and excise thin, necrotic conjunctiva and adjacent Tenon capsule along the outer aspect of the bleb.
- If the tissue is strong enough, resuture the scleral flap with 1 or more interrupted 10-0 nylon sutures.
- If resuturing of the scleral flap alone is insufficient, use a pericardial patch graft to provide additional resistance to aqueous outflow.
- Mobilize the conjunctiva by freeing its attachments to the sclera and superior rectus muscle.
- With a 9-0 monofilament polyglactin suture on a tapered noncutting needle, advance and reattach the conjunctiva to the limbus.