Glaucoma Tube | How to Place a Glaucoma Tube скачать в хорошем качестве

Glaucoma Tube | How to Place a Glaucoma Tube

ClearPath 250 Glaucoma Tube Shunt: Full Surgical Technique, Pearls & Pitfalls (Surgeon Education) Surgeon: Mohammed ElMallah, MD (@mohammedelmallah) Setting: Ocala & The Villages, Central Florida Audience: Ophthalmologists, glaucoma surgeons, fellows/residents, and eye-care professionals. Not patient-facing. This video demonstrates my complete workflow for implanting a non-valved glaucoma drainage device—the ClearPath 250 (New World Medical)—including exposure, plate positioning, tube ligation, AC entry, fixation, venting slits, patch graft placement, and conjunctival/Tenon closure. I discuss why I prefer smaller conjunctival incisions with ClearPath, how I avoid early hypotony, and steps that improve visualization and long-term tube stability. Learning Objectives By the end of this case, viewers should be able to: ➡️ Plan and execute a superotemporal conjunctival peritomy and sub-Tenon dissection for ClearPath 250 placement. ➡️ Understand non-valved tube strategy (no intrinsic flow restriction), including 7-0 Vicryl ligation, timing of suture dissolution (~4–6 weeks), and venting slits to mitigate early IOP spikes. ➡️ Choose needle gauge for AC entry (why I use 22-g for a reliable track and reduced peritubular flow). ➡️ Secure the plate and tube (e.g., 9-0 nylon eyelet fixation and mattress suture on the tube) to reduce migration/erosion risk. ➡️ Select and position a half-moon corneal patch graft over the tube and perform layered closure (Tenon to sclera followed by running-locking conjunctival closure). ➡️ Optimize tube length and angle relative to the cornea/iris plane and manage chamber stability with a paracentesis. Key Surgical Steps (high level) Traction suture & corneal protector for exposure Small peritomy with sub-Tenon dissection (posterior → anterior) 7-0 Vicryl ligation of tube (no rip-cord used) + BSS leak test ClearPath 250 plate inserted via small incision (folded/unfolded in the pocket) Eyelet fixation (superior plate, ~8–10 mm posterior to limbus) 22-g AC entry with angled approach; tube trimmed and inserted; position verified Venting slits created; tube mattress suture for stability Corneal patch graft placement; layered Tenon closure; running-locking conjunctiva Final checks: watertight paracentesis, tube position, AC depth/IOP Pearls & Rationale Why non-valved: predictable long-term IOP once capsule matures; early ligation avoids hypotony while capsule forms. No rip-cord: avoids a second procedure; dissolution timing of Vicryl typically suffices. 22-g track: smoother insertion and less peritubular seepage versus 23-g in my hands. Two-point tube fixation (when redundancy present): lowers mechanical erosion risk. Anterior eyelets & small incision: ClearPath allows lower-profile bleb and easier exposure. Instruments & Materials (representative) Sutures: 7-0 Vicryl (tube ligation), 9-0 nylon (plate/tube fixation), 8-0 Vicryl (conjunctiva) Needles: 22-g for AC entry Patch graft: half-moon corneal patch graft over tube Adjuncts: BSS, Wescott scissors, Weck-Cel/Waxcell sponges, speculum, cautery as needed Disclosures & Intended Use Education only; not medical advice. Techniques shown reflect my own preferences and training. Surgeons should adapt steps to their patient, device IFU, and institutional protocols. Device names mentioned: ClearPath 250, Ahmed FP7, Baerveldt 250/350 (for comparison). Connect & Cases YouTube: @mohammedelmallah X (Twitter): @eyemd76 Instagram: eyemd76 ➤ Subscribe for more surgeon-facing cases (glaucoma tubes, complex cataract, IOL strategies) and occasional patient-facing education. Keywords glaucoma drainage device, GDD, tube shunt surgery, ClearPath 250, New World Medical, non-valved tube, Ahmed FP7 comparison, Baerveldt 250, tube ligation 7-0 Vicryl, venting slits, hypotony prevention, 22-g AC entry, subconjunctival pocket, sub-Tenon dissection, corneal patch graft, mattress suture, tube exposure prevention, glaucoma surgery training, ophthalmology fellowship, surgical pearls, anterior chamber tube placement, superior-temporal quadrant, conjunctival peritomy, running locking closure