Abstract
BACKGROUND: A long glaucoma implant tube in the anterior chamber (AC) may cause intermittent or persistent tube-corneal endothelial touch.[1-3] This would result in corneal endothelial cell loss, corneal edema, and bullous keratopathy. Various minimally invasive techniques have been described for tube shortening or repositioning of the tube in the AC.[1-4] To shorten the tube, it can be trimmed within the AC to protect the corneal endothelium. PURPOSE: We describe a minimally invasive technique of trimming a long tube in the AC after Ahmed glaucoma valve (AGV) implantation for angle recession glaucoma. SYNOPSIS: Under local anesthesia, a corneal incision is made beside the tube entry point at the 12 o'clock position using an micro vitreoretinal (MVR) blade. Viscoelastic is used to separate the tube from the corneal endothelium. A half-inch 30-gauge needle is bent and passed from a paracentesis at 180 degrees across the tube entry site. The needle from the opposite end is advanced and docked inside the AGV tube. The excess length of the tube is transected with Vannas scissors. The end of the needle is externalized through the corneal incision, and the cut tube fragment is withdrawn by sliding a Sinskey's hook over the needle. The pliable silicone tube fragment is easily glided over the needle. Viscoelastic is aspirated, and the corneal incision is apposed using a 10-0 monofilament nylon suture. HIGHLIGHTS: The video describes a safe and easy closed chamber technique for trimming the long intracameral portion of the AGV tube without externalization, to correct the tube-endothelial touch. VIDEO LINK: https://youtu.be/WdQtax8T45w.