I was recently challenged by a very daunting situation during a filtering glaucoma procedure I thought I should share with my colleagues.
A 68-year-old male patient had previously undergone 25G pars plana vitrectomy with silicone oil tamponade and endolaser photocoagulation for a retinal detachment in his right eye 4 years ago. Three years later, after phacoemulsification and intraocular lens implantation, he developed glaucoma. He was on maximal medical therapy and uncontrolled intraocular pressure. I thought the best option for him was a mitomycin-C trabeculectomy. During surgery, I noticed that the scleral flap was very thin but proceeded with the surgery. I placed two sutures with 10-0 nylon on a spatula needle on each corner of the flap and noticed a greater flow through the nasal aspect of the flap. I decided to place a third suture when a larger than usual hole developed and increased to a complete tear when tying the knot. Balanced salt solution (BSS) was flowing...
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The author declares that he has no conflict of interest.
The patient has consented to the submission of the letter to the editor to the journal.
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