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Video Report

Dissection of the Trabeculectomy Bleb Pocket using a Novel Dissecting Instrument

Department of Ophthalmology, Hadassah – Hebrew University Medical Center, Jerusalem, Israel.

Correspondence: Eytan Z Blumenthal, MD
Tel: 972-2-677-6580; Fax: 972-2-644-7478 Email: eblumenthal{at}md.huji.ac.il

Date of acceptance: 28th February 2006

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Introduction

Scarring, and ultimately bleb failure, is a common drawback of modern trabeculectomy surgical technique [1]. Such fibrosis is often apparent after trabeculectomy surgery in a pattern referred to as the "ring of steel", surrounding the trabeculectomy flap site in a ring-like pattern. This scarring is situated at the level of the Tenon's capsule-episclera interface. Various approaches have been introduced towards the reduction of scarring, amongst them a gentle surgical technique, corticosteroids and anti-scarring agents. Newer wound modulation approaches are currently under investigation [1]. In the enclosed video a novel approach is presented, namely a smooth atraumatic dissection of the bleb pocket utilizing a Conjunctiva Dissector.

Technique

The Conjunctiva Dissector (Katena (K3-1124), Denville, New Jersey) features a highly polished rounded, 2mm wide disk-shaped tip connected to a 21mm shaft, mounted on a standard round handle. The polished finish of the distal sphere permits it to penetrate between tissue planes in a smooth, atraumatic manner. Its disk-like shape allows gentle rocking motions to penetrate between, and separate, tissue planes. Consequently, it becomes feasible to dissect along a tissue plane while minimizing any micro-trauma to the adjacent surfaces. Once the correct path is identified by the surgeon, the tip of the instrument can be slipped in, and, with the aid of gentle rocking movements, dissect a large bleb pocket. Utilizing this technique makes it possible to create a very large dissected bleb pocket through a relatively small opening, and with minimal disturbance to neighboring tissues.

Comments

The accompanying video presents the dissecting technique in an eye undergoing its first trabeculectomy, in a case of repeat trabeculectomy, and in two eyes heavily scarred from previous surgery.

Conflict of Interest Statement

The author has no proprietary or financial interest in this instrument bearing his name, the Katena Blumenthal Conjunctiva Dissector (K3-1124).

Reference

• Atreides SP, Skuta GL, Reynolds AC. Wound healing modulation in glaucoma filtering surgery. Int Ophthalmol Clin 2004;44(2):61-106.