The Vicryl Tie Technique for Inserting a Draining Implant in the Treatment of Secondary Glaucoma

Abstract

We have reviously described surgical techni ues for draining severe cases of secondary glaucoma by means of% artificial implant Wherever posshe these implants have been inserted in two stagesThe modern microsurgical operation of trabeculectomy gives excellent results in selected cases of primary glaucoma. However, where glaucoma develops in young patients or is associated with trauma, aphakia, chronic uveitis, anterior segment neovascularisation or failure of a previous drainage operation, results are generally poor. In the latter group, we use a draining implant consisting of a thin silicone tube connected to drain on to the upper surface of one or two rigid circular episcleral plates. These implants are placed with the silicone tube lying in the angle of the anterior chamber and the plate or plates firmly sutured to the sclera and covered by a thick flap of Tenon's tissue and conjunctiva.The aqueous that is drained by these implants passes through the tube to enter a cleft between the episcleral plate and the overlying tissues. From this cavity it escapes freely in the first seven to ten days after operation. During this time the intraocular pressure (IOP) is very low, ranging between 0 and 5 mmHg. This period of hypotension ceases when the tissue reaction to the presence of the implant and to the aqueous

Results of the Susanna implant in patients with refractory primary congenital glaucoma

“…10,13,26,29 Similar to our results, Munoz et al 26 reported an unfavorable influence of younger age on decreasing success of the procedure. In their series, patients operated after 5 years of age had a success rate of 88%, whereas those operated from birth to 2 years of age had a success rate of 68%.…”

Management of Uncontrolled Glaucoma With the Molteno System

“…In no case did formed vitreous occlude the tube. In 12 eyes (eyes 8,9,17,18,26,27,28,31,33,34,35,36) the peak IOP during the postoperative period of ocular hypertension was higher than it had been before operation, and in seven eyes (eyes 11,21,22,24,25,30,37) it was almost as high (excluding eye 3, in which pupillary block was the mechanism for the raised IOP). Visual acuity fell in five of these 19 eyes, compared with four of the remaining 16 (excluding eyes 14,19,20).…”

Use of the Single-Plate Molteno Implant in Refractory Glaucoma

“…In the "two-stage' procedure the footplate is sutured into position to allow a fibrous capsule to form around the plate, and then 4-6 weeks later the tube is inserted into the anterior chamber [ 19]. In this series, the problem of excessive post operative hypotony was resolved by tying an absorbable suture around the tube, which al lowed the tube to open spontanteously about 5 weeks after surgery [20] (fig. 1).…”