Deep Sclerectomy, Step by Step

Dr. Hassan Khaled walks us through each step of a deep sclerectomy procedure. A 7-0 silk transcorneal traction suture is used to rotate the globe to expose the chosen surgical site, then the conjunctiva is dissected with wet-field cautery. A metal blade is used to highlight a superficial scleral flap about 5 mm square. Then, a deep scleral flap is dissected, leaving about a 5- to 10-micron scleral bed until reaching the scleral spur. After a side port is opened, he continues dissecting about 1 mm in the clear cornea, precutting the deep scleral flap using the metal blade, and completing the cutting with microscissors. After peeling the inner wall of the Schlemm canal, a percolation through the trabeculo-Descemet membrane is revealed. Final steps include closing the superficial scleral flap with loose 10-0 nylon suture, injection of a heavy viscoelastic material into the intrascleral space, and closing of the conjunctiva using 10-0 nylon suture.

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