I was fortunate to see the Video Film Festival entries for the World Glaucoma Congress back in June of this year when a friend of mine was asked to judge the submissions. One that caught my attention as being potentially incredibly useful was a technique by Dr R Gupta from India to use a suture to pull a glaucoma tube away from contact with the corneal endothelium.
This video shows me using a similar technique based on what I remembered from seeing that video once. Dr Gupta’s technique may have been different and I have only done this on the one patient shown in this video. However, this is such a promising idea that I know I will be doing this again. It is far easier to use a 10-0 mersiline double-ended suture to pull back a tube tip than to perform a major re-operation that would have involved opening the prior surgery site, cutting away extensive scar tissue, lifted up the donor sclera flap, reposition the tube entry site, then closed things up again.
This patient went from IOP into the 40s on medical therapy to the low teens or lower without medical therapy by having this suture technique to pull the tube back from the cornea.