Single snip trabeculectomy using a specially designed punch.
A special trabeculectomy punch designed by one of the authors is described. The surgical technique and advantages of the punch method are discussed.
Equipment Design↗
Biomedical subjects
K F Tomey
Publications and source records attributed to K F Tomey.
The use of a cautery for trimming exposed nylon sutures.
Ophthalmic nylon sutures (9-0 or 10-0) that become exposed postoperatively are irritating to the patient, especially if the knots are not buried, or if the sutures are not well covered by (or protrude through) the conjunctiva. Obviously, these sutures cannot be removed safely less than six to eight weeks after surgery. The symptoms may even be aggravated by trimming the suture ends, as these become more stiff and pointed when shortened. Moreover, trimming sutures can be a difficult task in some uncooperative patients.
Cautery↗
The glaucomas in aphakia and pseudophakia.
Intraocular pressure may become temporarily or permanently elevated at various intervals following cataract surgery. There are several mechanisms by which glaucoma develops as a complication of the cataract extraction itself. The presence of a pseudophakos may or may not contribute to the pathogenesis. Important diagnostic clues include the anterior chamber depth, the presence or absence of an iridectomy, gonioscopic findings, and the appearance of the optic nerve head. Life-long medical treatment is frequently justified, as alternative laser or surgical modalities may not be successful. The exact causes for high failure of filtration surgery in aphakic eyes is not clearly understood; scarring of the conjunctiva, the vitreous, and altered characteristics of the aqueous humor have all been incriminated. Current research to improve surgical success includes the development of effective artificial drainage implants or the use of pharmacologic modulators of wound healing, which promote filtration by preventing scar formation.
Aphakia↗
Clinical experience with the Molteno implant in advanced infantile glaucoma.
The alternatives in the management of infantile glaucoma refractory to conventional treatment are quite limited and unrewarding. We did a retrospective study of 49 patients (53 eyes) under 12 years of age with advanced, uncontrolled glaucoma who each underwent implantation of a single-plate Molteno implant in one stage. Over the follow-up period ranging from 6 months to 3 years (mean 18 months), 36 of the 53 eyes (68%) had an intraocular pressure less than or equal to 21 mm Hg and were considered a success. Fourteen eyes (26%) required further glaucoma surgery, 2 eyes developed severe chronic hypotony, and 1 eye lost light perception following endophthalmitis. The number of anti-glaucoma medications was decreased from a mean of 2 (+/- 1) to 1 (+/- 1). The probability for success of the Molteno implant in controlling glaucoma increased with the age of the patient. Six eyes (11%) were late failures, most probably due to fibrous encapsulation of the bleb. Complications observed were: prolonged hypotony and flat anterior chamber, retinal detachment, migration of the tube, erosion of the tube through the conjunctiva, and an ingrowth of fibrous tissue in the anterior chamber. We consider the Molteno implant to be a reasonable option in the management of difficult cases of infantile glaucoma.
Child↗