AGS 2017
    Glaucoma, Surgical Management

    Dr. Elena Bitrian demonstrates her technique for bleb revision for hypotony:

    1. Use Westcott scissors to sharply dissect and excise thin, necrotic conjunctiva and adjacent Tenon capsule along the outer aspect of the bleb.
    2. If the tissue is strong enough, resuture the scleral flap with 1 or more interrupted 10-0 nylon sutures. 
    3. If resuturing of the scleral flap alone is insufficient, use a pericardial patch graft to provide additional resistance to aqueous outflow.
    4. Mobilize the conjunctiva by freeing its attachments to the sclera and superior rectus muscle.
    5. With a 9-0 monofilament polyglactin suture on a tapered noncutting needle, advance and reattach the conjunctiva to the limbus.