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Technique Bezhu: trabeculectomy with laxative sutures
Last reviewed: 19.10.2021
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This article presents a technique for trabeculectomy using laxative sutures for suturing the scleral flap. Initially, make a small L-shaped conjunctival incision length of 4 to 2 mm at a distance of 1-2 mm from the limb. This size of the incision provides the necessary space to create a scleral flap. If necessary, hemostasis is performed. Further, a scleral flap measuring 3 by 4 mm is formed, its thickness is 2/3 of the thickness of the sclera. Using a Week-cell sponge for 2 to 3 minutes, mitomycin-C 0.4 ml / dL without a conjunctival sponge coating is applied. After treatment with mitomycin-C, the operating field is washed with physiological solution (60-80 ml). Paracentesis is performed, the scleral flap is detached anteriorly until the descemet membrane is reached so that a valve-like incision is obtained. After opening the anterior chamber, sclerectomy is performed using the Kelly perforator for the descemet membrane, then the peripheral iridectomy with the help of the Vance scissors. The scleral flap is fixed with a loosening suture, using a monofilament nylon thread 10-0. The procedure is the following:
- needle injection into the sclera in the temporal corner, puncture at the base of the scleral flap;
- stitch is carried through the flap;
- injection of the needle is made on the surface of the flap under the conjunctiva in the limb region towards the cornea, puncture the needle on the transparent part of the cornea 1 mm from the limb;
- the same needle makes a stitch in the opposite direction (insert a needle on the transparent part of the cornea 1 mm from the limb, removed on the flap superficially);
- stitch is carried through the flap;
- needle injection at the base of the flap, puncture on the sclera in another corner.
As a result, the surgeon receives three loops: two above the scleral flap, one above the cornea. The loose ends of the seam are connected to the corresponding loop on the flap. Using only one of the three loops, then cut off. The conjunctiva is sewn with a mattress suture with the same monofilament nylon thread 10-0, superficially above the flap and parallel to the limb directly under the remaining conjunctiva, covering the horizontal part of the L-shaped incision. The rest of the cut is closed with a knot, fixing first the epicler, and then the conjunctiva. Thus, the conjunctiva is sealed.
If it is necessary to remove the seam, the loop is cut off on the surface of the cornea, and then extracted with tweezers. This manipulation is carried out under a slit lamp using local anesthesia, it is necessary to observe the surgeon at least 48 hours after the manipulation or during two long observation periods.
With combined interventions (for cataracts and glaucoma) use a single approach. Modifying the procedure, form a partial scleral flap, reducing half the length of lateral incisions. Get a flap 2 by 4 mm in size 2 mm from the limb. After the application of mitomycin-C, a scleral tunnel is created with the help of a sickle-shaped knife, continuing the previously begun furrow, exfoliate the scleral flap. Then phacoemulsification is carried out with the implantation of an artificial lens, a sclerectomy is performed using the Kelly perforator for descemet membrane and peripheral iridectomy. The scleral flap and conjunctiva are sutured according to the previously described technique.