Results of GT’s 2014 Film Festival
I am proud to announce that the winner of GT’s first Film Festival is Soosan Jacob, MS, FRCS, DNB, a senior consultant ophthalmologist at Dr. Agarwal’s Eye Hospital and Eye Research Centre in Chennai, India. Her video, “Tube Tribulations,” demonstrates a tour de force of approaches and techniques for the placement of glaucoma tube shunts. An image from Dr. Jacob’s well-crafted video appears on the front cover of this issue.
More than 20 videos were submitted to the film festival, showcasing the full range of approaches to glaucoma sur- gery. Runners-up to the winning video demonstrate filtration surgery, microinvasive glaucoma surgery, cyclophotocoagulation, and a tube shunt procedure.
I encourage you to visit Eyetube.net to view the winning videos as well the complete collection of videos submitted to the film fes- tival. I look forward to covering this fantastic library of new surgical videos in future installments of “Inside Eyetube.net.”
—Nathan M. Radcliffe, MD, section editor
WINNING VIDEO TUBE TRIBULATIONS
In her video, Dr. Jacob demonstrates her technique for implanting an Ahmed Glaucoma Valve (New World Medical) and shares various tips and tricks to avoid complications. First, Dr. Jacob sutures the plate so that the tube lies perpendicular to the limbus. Next, she marks the flap around the tube as it would lie in its final position. This step ensures that the flap covers the tube and also allows the tube to pass into the eye in a straight line, without any kinks or directional changes. To prevent tube migration, extrusions, and erosions, Dr. Jacob creates a robust 5- × 5-mm flap from the sclera, makes a tangential entry into the eye so that the tube does not make any sudden turns, keeps the needle entry into the eye for the tube as tight as possible, and places an anchoring knot in the sclera with 8–0 nylon sutures around the tube to prevent it from shifting due to eye movement. She also places tight sutures on the scleral flap on either side of the tube to sandwich it under the flap. If available, Dr. Jacob applies fibrin glue under the scleral flap and molds the flap around the tube. The glue, however, should not be allowed to seep posteriorly into the subconjunctival/Tenon pocket. In pseudophakic eyes, Dr. Jacob recommends placing the tube behind the iris and in front of the IOL to keep the tip away from the corneal endothelium. All of these maneuvers, Dr. Jacob explains, decrease the tube’s ability to move.
SLIT-LAMP–BASED SURGICAL EXcISION OF AN OVERHANGING BLEB
By Shakeel Shareef, MD, University of Rochester School of Medicine
Bleb dysesthesia can occur years after successful filtration surgery. A challenge glaucoma surgeons face is to relieve the symptoms of bleb dysesthesia without compromising the original filtering bleb. In his video, Dr. Shareef demonstrates slit-lamp–based confirmation of both optical coherence tomography and ultrasound biomicroscopy findings of an overhanging bleb. After careful assessment, Dr. Shareef successfully excises the overhanging bleb, with no evidence of bleb leak or bleb failure postoperatively. Dysesthesia resolved, and bleb function was preserved several months after the procedure.
ULTRASONIC CIRCULAR CYCLOPHOTOCOAGULATION
By Florent Aptel, MD, PhD, University Hospital of Grenoble, France
Dr. Aptel and colleagues developed a ring-shaped device (EyeOP1; EyeTechCare) that allows surgeons to selectively coagulate the ciliary body with high-intensity focused ultrasound. The device comprises a coupling cone, which is located against the eye and allows the surgeon to place and center the device, and a therapeutic probe, which is inserted into the coupling cone and has six piezoceramic transducers. Each of the transducers selectively coagulates a part of the ciliary body.
In his video, Dr. Aptel performs ultrasonic circular cyclophotocoagulation in an eye with primary open-angle glaucoma. He discusses this method’s mechanisms of action as well as the first results of both completed and ongoing clinical trials evaluating this new procedure. According to Dr. Aptel, many experimental and clinical findings suggest that ultrasound cyclocoagulation lowers IOP, both by decreasing the aqueous production and increasing the aqueous outflow by the uveoscleral pathway.
TRABECULAR BYPASS SURGERY WITH INTRAOPERATIVE FLOW CONTROL
By Gabor Scharioth, MD, PhD, Aurelios Augenzentrum, Recklinghausen, Germany
According to Dr. Scharioth, implantation of a trabecular microbypass stent reduces IOP more effectively if the device is placed next to a collector channel. This video demonstrates an intraoperative flow-control technique to verify the successful positioning of the stent and flow through Schlemm canal, collector channels, and episcleral veins. If natural outflow is not re-established, Dr. Scharioth recommends reimplanting the stent on the other side of the collector channel.
ENDOSCOPICALLY GUIDED BAERVELDT TUBE SURGERY
By Imran Masood, BSc, MBChB, MRCS(Ed), FRCOphth, Optegra Birmingham Eye Hospital, United Kingdom
In an aphakic eye with microcornea and corneal decompensation with uncontrolled IOP, Dr. Masood implants a Baerveldt 250-mm2 glaucoma implant (Abbott Medical Optics) with the tube’s positioning guided by an intraocular endoscope.
Section Editor Nathan M. Radcliffe, MD, is an assistant professor of ophthalmology at Weill Cornell Medical College, New York-Presbyterian Hospital, New York. Dr. Radcliffe may be reached at (646) 962-2020; firstname.lastname@example.org.