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Trabeculectomy with Express Mini Shunt with Mitomycin C

Tyler Q. Kirk, MD performs Trabeculectomy with Express Mini-shunt and Mitomycin C for a patient with uncontrolled severe open angle glaucoma. Trabeculectomy surgery is still the best way to achieve intraocular pressure of 8-12 mm Hg. Some patients require very low pressure to stop the advancement of their glaucoma. A formix based flap is preferred due to its ability to achieve superior long term filtering bleb morphology, as Dr Peng Khaw has written about. The Express mini-shunt decreases early hypotony allowing patients a more stable post operative course, and creates a more controlled intra-operative experience as it has a 50 um opening to limit the flow of aqueous. The shunt is made of stainless steel but due to its small size and secured location under the scleral flap, it has been deemed MRI compatible, and should not cause any issues with metal detectors. The scleral flap is tensioned first with slip knots and once adequate flow is confirmed these knots are locked. The conjunctival closure is meticulously performed in accordance with the Condon Wise Closure technique, for which Dr Kirk wrote the paper during his fellowship. This closure technique has the lowest likelihood for early leakage, having no leaks greatly increase the chance for long term success with trabeculectomy surgery ( https://pubmed.ncbi.nlm.nih.gov/24480.... Mitomycin C can vary in concentration to meet individual patient needs; it has helped tremendously in reducing scarring and failure of filtering blebs by killing (apoptosis) fibroblasts.