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| Name | Ab interno bleb revision |
| Video Uploader | Video From AIOS Scientific Committee |
| Upload Date | This Video Uploaded At 12-06-2024 11:07:18 |
| Video Discription | Sub-scleral release of fibrosis may be a little tricky owing to the blind nature of the procedure and the possibility of injury to underlying structures with the sharp needle. External bleb repair is a more invasive surgery requiring conjunctival dissection and reopening of the scleral flap. A newer procedure an ab-interno sub-scleral revision technique has been described, and it appears to be a less invasive procedure with a more controlled and predictable approach. A gonioscopy is mandatory to document an open sclerostomy since the spatula will enter the subscleral space through this opening. Pre-surgery preparation for ab-interno bleb revision 1. Office-based slit-lamp procedure, to be done 5 days before surgery. 2. Subconjunctival injection of anti-metabolite agent MMC 0.1 mg/ml (0.1 ml) injected in sub-tenon plane using a 30 G needle and 1 ml syringe, in the region of the failed bleb. The injection is then spread using a cotton swab. Under aseptic conditions, two side ports are made at 2 o'clock and 6 o'clock position, followed by injection of pilocarpine. Anterior chamber is formed with viscoelastic and gonioscopy is performed to visualize the sclerostomy site. The Grover- Fellman sclerostomy internal bleb revision spatula (Epsilon USA) is then introduced from the inferior side port and under visualization through a gonioprism, is passed through the sclerostomy site. With gentle horizontal swaying motion, a blunt dissection is carried out beneath the scleral flap. The spatula is then further advanced carefully in a similar fashion to break the fibrotic adhesion between the sclera and the tenons posteriorly. This re-establishes the free flow of aqueous through the sclerostomy in the sub-tenons space, thus seen as formation of a bleb. |
| Category | Education |
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