How I Fix Glaucoma Tube Exposure скачать в хорошем качестве

How I Fix Glaucoma Tube Exposure

Optometrists and ophthalmologists: anytime you are seeing a patient who has had a glaucoma tube, essential to check for tube erosion or tube exposure. Every visit. Have the patient look down, raise the lid, inspect the tube. This video demonstrates the surgical management of an exposed tube. I free up the conjunctiva directly adjacent to the tube, fashioning a subconjunctival pocket on each side of the tube and dissecting the subconjunctival space both anteriorly and posteriorly in order to create space for the patch graft. Here I am using a corneal patch graft. I then tuck the patch graft into the subconjunctival pocket. Often the space is tight enough such that there is no need to suture the patch graft. I then close the conjunctiva over the patch graft. If I am not able to free up enough conjunctiva to achieve closure here, then plan B is to make a limbal conjunctival peritomy with a conjunctival relaxing incision and rotate more conjunctiva to cover the tube. This is demonstrated nicely in a video by Dr. Hassan Khaled linked below    • Tube Exposure  Repair   Plan C if there is still not enough conjunctiva is to use an amniotic membrane over the patch graft, secure the edges of the conjunctiva to the amniotic membrane and let the conjunctiva heal over the amniotic membrane by secondary intention. When doing surgery, important to have Plan B and Plan C. I first uploaded this Patch Tuck procedure in 2024.    • Tube Revision for Exposure: Patch Tuck Pro...   We can achieve the goals of patch graft reinforcement and conjunctival closure with minimal dissection of the ocular surface. This procedure works well if the conjunctiva posterior or nasal to the area of exposure can be readily freed up. This procedure has become my Plan A for Tube revision for exposure.