Fig 1 - uploaded by Faisal Ahmed
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Picture a Microscope image (left picture) shows trabeculodescemetic window after dissection of the deep scleral flap. iOCT image (right picture) shows SC before dilating the ostium of SC using the iTrack microcatheter (white arrow). Picture b Microscope image (left picture) shows the progress of microcatheter into SC. Red light indicates the position of the microcatheter tip in the SC. iOCT image (right picture) shows the microcatheter in the SC (white arrows) Picture c Microscope imaging shows the final step of retraction of the microcatheter with simultaneous injection of Healon GV into the SC. iOCT image (right picture) shows the enlarged SC (white arrow) Picture d Intraoperative UBM image: TM thickness measurement after SC viscodilation. Picture e, f Intraoperative UBM image: horizontal and vertical diameter of SC after viscodilation. Picture g, h Intraoperative UBM image: AC angle before (g) and
Citations
... The senior surgeon FA had already described a 2-stage scleral reinforcement with GDD implant, with the thin sclera reinforced in the first operation, and 1 month later, a GDD was implanted (5). ...
... Although the senior author FA had already described a two-step procedure of scleral reinforcement with pericardial Tutoplast Tm surgery initially with glaucoma tube implant as a second procedure 1 month later, this would have meant 2 anesthetics and delay in IOP control (5). Therefore, it was decided to perform a one surgery scleral strengthening and tube surgery-using the "TAG sandwich technique" under general anesthetic. ...
... Our combined "TAG sandwich" technique allowed most of the suturing to be into the Tutoplast Tm avoiding suturing directly into the sclera, ensuring safe plate fixation (13). A two-staged procedure was described earlier by the senior author FA in cases with scleral thinning, to achieve scleral strengthening (5).This novel combined procedure has the advantage of minimizing the number of procedures required under general anesthetic and implanting the GDD immediately for more timely intraocular pressure control. ...
Purpose:
Refractory glaucoma patients continue to require surgical intervention in the form of trabeculectomy surgery or glaucoma drainage device (GDD). Those patients that require a GDD but have thin sclera or scleromalacia present a challenge.
Methods:
In this article, we present a novel "TAG sandwich" single surgical procedure in which thinned sclera is reinforced with a pericardial patch graft ("bottom layer of the sandwich") allowing safe implantation of the GDD ("the tube sandwich filling") and then placing another patch graft on top of the tube part of the GDD ("top layer of the sandwich"). The surgery was performed on an open-angle glaucoma patient with a generalized thin sclera and uncontrolled intraocular pressure despite maximal topical medication and oral acetazolamide.
Results:
Reinforcing a compromised sclera with a pericardium patch graft allowed the safe implantation of a glaucoma drainage device. The patient's intraocular pressure was safely controlled at 7 mmHg almost 1-year postsurgery without intraocular pressure-lowering drops.
Conclusions:
This scleral strengthening procedure can be considered by readers in other ocular surgeries where there is a risk of scleral perforation, as well as part of a combined surgery where refractory glaucoma patients with thin sclera require scleral reinforcement to allow for safer implantation of a glaucoma drainage device.
Aim: To summarize the history and current trends in the use of scleral grafts in ophthalmology. Materials and methods: We conducted a review of the literature through the MEDLINE and Cochrane Library databases. The search terms were "sclera", "graft", and "surgery". The search resulted in 1596 articles, of which we evaluated 192 as relevant. The relevant articles were sorted chronologically and according to the method of using scleral grafts, which enabled the development of a review article. Results: The sclera has been routinely used in ophthalmology since the 1950s in many different indications. Some of these indications have become practically obsolete over time (for example, use in the surgical management of retinal detachment), but a large number still find application today (especially use in glaucoma or oculoplastic surgery, or as a patch for a defect in the sclera or cornea). Conclusion: Even though allogeneic sclera is currently used less frequently in ophthalmology compared to other tissue banking products and the range of its indications has partially narrowed, it remains a useful material due to its availability and properties.
