Saving Non Penetrating Deep Sclerectomy Glaucoma Surgery From Micro Perforation

A case of male patient 65 years old with open angle glaucoma. Presented to me with high IOP 33 mmHg in spite he was on the full glaucoma medication. He is pseudophakia for 10 years. His was with advanced glaucomatous optic nerve status. All the pre-operative data, operative video, post-operative photos and UBM photos are going to be presented.

Watany Eye Hospitals, Cairo, Egypt

During my routine deep sclerectomy non penetrating glaucoma surgery, accidental micro perforation was happened.

In spite I converted to penetrating trabeculectomy, I managed in a way to control this micro perforation through intraoperative IOP control, plugging the micro perforation with Modulating Mechano-Transduction high cross-linking implant and then continued the deep sclerectomy using the glaucoma clip.

Second day post operative, IOP was 8 mmHg, deep AC, diffuse formed bleb and round regular reactive pupil with quiet eye. One week post operative, IOP was 13 mmHg with diffuse formed bleb. Two months follow up IOP was 16 mmHg with no glaucoma medication with well-formed bleb.

All anterior segments photo slit lamps during the follow ups with be shown and UBM after three months will show how the filtration is quite good instead of the accidental micro perforation was happened during surgery.

Never lose hope in deep sclerectomy even when micro perforation is happening but with the proper tools of management you can save non penetrating glaucoma surgery from converting to penetrating glaucoma surgery.