PMC3998861_01
Patient 1 surgical procedure.. Notes: (A) A clear corneal traction suture is created with a 6-0 polyglycolic acid (PGA) absorbable violet braided suture (Mani Inc, Tochigi, Japan). (B) The scleral flap is dissected until the aqueous humor egresses. (C) The fornix-based conjunctival flap is closed with 10-0 nylon sutures. (D) A 350-mm2 Baerveldt glaucoma implant is positioned. The tube is tightly occluded using an 8-0 PGA absorbable violet braided suture (Mani Inc) ligature (arrow). (E) The tube is inserted into the anterior chamber. (F) Tube fenestrations are created. (G) A scleral graft is used to cover the tube. (H) *bleb formation is observed at the end of the surgery.
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Tochigi, Japan) was placed in the peripheral cornea, and the area of the failed bleb in the superonasal quadrant was exposed (Figure 2A). The scarred conjunctiva was dissected posteriorly using blunt-tip scissors. A bare scleral flap was dissected using an ophthalmic knife until the aqueous humor egressed (Figure 2B). The fornix-based conjunctival flap was re-approximated to the limbus and closed with 10-0 nylon sutures at each end of the periotomy (Figure 2C). A subconjunctival space in the inferotemporal quadrant was then created, and a 350 mm2 Baerveldt implant (Abbott Medical Optics Inc., Santa Ana, CA, USA) was positioned under the inferior and temporal rectus muscles (Figure 2D). The tube was then cut bevel up, and inserted into the anterior chamber via a needle track created with a 23 gauge needle (Figure 2E). To achieve early IOP control, a needle was used to penetrate both sides of the tube (ie, tube fenestrations were created) in three places (Figure 2F). A scleral graft was used to cover the outer portion of the tube (Figure 2G). Bleb formation was observed after irrigation with balanced salt solution through the paracentesis (Figure 2H).
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PMC3998861_03
Changes in the postoperative intraocular pressures in the three cases.. Notes: The black arrows indicate the presumed times when the ligatures around the tubes dissolved. The white arrow indicates when bleb needling was performed in patient 2.. Abbreviation: IOP, intraocular pressure.
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The changes in the postoperative IOP levels of the three patients are shown in Figure 3.