Standard Glaucoma Surgery and the Shallow Anterior Chamber/Extensive PAS

Dr. Sameh Mosaed discusses how the shallow anterior chamber/extensive peripheral anterior synechiae (PAS) post a unique challenge for physicians and how minor modifications can optimize success. Trabeculectomy modifications include concurrent cataract extraction and IOL implantation, tight scleral-flap sutures, careful conjunctival closure, and iridectomy. For tube shunts, Dr. Mosaed suggests erring on the side of the tube resting on or near the iris with a long bevel as opposed to closer to the cornea. Shorter tubes, cycloplegics, smaller-gauge needles, and sulcus tubes are also helpful modifications that can increase the odds of success.