This 50 y.o. patient underwent a trabeculectomy with mitomycin-C then developed progressive hypotony maculopathy as well as a cataract. After concluding the cataract portion of the surgery, I placed a suture through the conjunctiva and its underlying scleral flap supratemporally. This video shows this portion of the surgery.
This procedure has been described already in the literature and I do perform it albeit infrequently. You have to be cautious if the bleb is too thin as you can end up with a permanent leak. In the weeks following the surgery, the nylon suture gets buried UNDER the conjunctiva.
A week after the surgery, this patient was seen by her local optometrist, as the patient is several hours away from the nearest ophthalmologist and almost a full day away from me. The optometrist called in a bit of a panic to say the patient’s bleb had a crease in it! I was able to reassure him that this was the plan. Also, encouragingly, the eye pressure was now 23mmHg instead of its pre-op value of 4.