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Surgical Technique | Nov 2012

Scleral Fistula Closure at the Time of Glaucoma Drainage Device Tube Repositioning: A Novel Technique

Joseph F. Panarelli, MD; Michael R. Banitt, MD, MHA; Paul A. Sidoti, MD

Arch Ophthalmol. 2012;130(11):1447-1451. doi:10.1001/archophthalmol.2012.2219.

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ABSTRACT

Repositioning a glaucoma drainage device tube from the anterior chamber to the ciliary sulcus or pars plana can be a challenging procedure owing to the difficulty in obtaining tight closure of the original limbal fistula. Failure to achieve watertight and airtight closure of the fistula can result in substantial difficulty in completing other key portions of the surgery and may lead to postoperative hypotony and associated complications. A novel technique using a Tutoplast scleral plug, polyglactin sutures, and, in certain cases, fibrin tissue sealant to close a limbal fistula at the time of glaucoma drainage device tube repositioning is described. This technique can be replicated with ease and provides a tight seal so that other concurrent surgical procedures can safely be completed and postoperative hypotony is avoided.

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Figure 1. A dry, wedge-shaped piece of Tutoplast sclera is prepared for insertion into the corneoscleral fistula. The narrow end is inserted into the track. After subsequent hydration and expansion of the plug, the remaining tissue is trimmed flush with the surrounding sclera.

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Figure 2. The scleral plug has been inserted into the fistula and the track is closed with an 8-0 polyglactin suture. The suture incorporates the plug and thus prevents migration of the plug into the eye or out of the fistula.

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Figure 3. Preoperative photograph from case 3 illustrates the recurrent conjunctival erosion with exposure of the inferotemporal plate of the glaucoma drainage device and anterior aspect of the scleral patch graft.

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Figure 4. Postoperative photograph from case 3 demonstrates no recurrence of the conjunctival erosion and a quiet eye despite slight protrusion of the scleral plug into the anterior chamber at the 5-o’clock position.

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Panarelli JF, Banitt MR, Sidoti PA. Scleral Fistula Closure at the Time of Glaucoma Drainage Device Tube Repositioning: A Novel Technique. Arch Ophthalmol. 2012;130(11):1447-1451. doi:10.1001/archophthalmol.2012.2219.

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Scleral Fistula Closure at the Time of Glaucoma Drainage Device Tube Repositioning: A Novel Technique

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