A couple of months ago, when I could not find one of the two mitomycin soaked 8x8mm instrument wipe sponges I had placed in the sub-tenon’s space, the first time this has happened in an estimated 2,000 surgical cases over 16 years, I thought…well, this won’t ever happen again. When it happened again a couple of weeks ago; I knew that it was time to change my technique of mitomcyin application.
I posted a message on our American Glaucoma Society listserv and was overwhelmed with responses from others this had happened to as well and also with the reassurance that nobody seemed to have any untoward complication as a result of the retained sponges; likely because Mitomycin is actually derived from an antibiotic. One interesting suggestion was to pass a suture through each sponge and pull it out when done. A few weeks later there was a whole new posting by another member who realized the potential medico-legal implications of a retained foreign body. By this point I had already tried the suture technique and then this mini neuropatty method that came about by Juanita and Celia in the operating room realizing they might be the ideal solution. In the latest flurry of AGS listserv postings, others mentioned just using very long pieces of sponges that hang out to the limbus so they can’t be lost.
The advantage of this technique using the mini neuropatties is that this allows for posterior application of the mitomycin; in keeping with the current preferred technique. With such a posterior application over a very large area, we can achieve very low and diffuse blebs instead of the small, high blebs that overhand the corneal-scleral limbus and cause pain and risk infection.
Now that medico-legally there may be fears of retained foreign bodies by using cut pieces of sponges, this technique is worth considering and has been working quite well for me the past few weeks.
March 23, 2010 reader comment:
Do you have any order info for the neuropatties? I did a trab yesterday in a guy with poor exposure (read prominent brow and no orbital fat). My sphincter tone was high after watching your video so I drove 6'0 sutures through the light shields before placing them posteriorly. The neuropatties would be much easier.
March 23, 2010 my response:
The manufacturer is Codman, distributor is Johnson & Johnson and the vendor ID is 801399. The surgical patties are sold by the case of 20 at $8.95 each. Please let me know if this information is helpful.
Robert M Schertzer, MD, MEd, FRCSC
March 24, 2010:
Many thanks, I doubt it will break the bank in our ASC.
March 31, 2010 reader comment:
I must say Rob..... you have to have a really strong stomach to do what you do.....
(These comments were copied from original submission dates and posted as a journal follow-up article in preparation for changing to DISCUS for future commenting on my blog.)