In this video, a 7-month-old patient presenting with primary congenital glaucoma and corneal clouding has an ab externo trabeculotomy performed on her left eye. The procedure begins with subconjunctival dissection and formation of a temporal scleral flap to locate the back wall of Schlemm’s canal (SC). A 270-degree circumferential trabeculotomy is performed with an illuminated microcatheter. The microcatheter is blocked from completing a full 360 degree pass due to scarring from a previously failed superior trabeculectomy. A scleral cutdown is used to retrieve the microcatheter. Another 40 degrees of trabecular meshwork (TM) is incised in the opposite direction using a metal trabeculotome.
School: Massachusetts Eye and Ear
Punctal Dilation and Mini-Monoka Stent Insertion
This video demonstrates punctal dilation and insertion of a Mini-Monoka stent for treatment of epiphora due to punctal/canalicular stenosis.
Lacrimal Probing and Irrigation
This video demonstrates lacrimal probing and irrigation to investigate the anatomy, patency, and functional status of the lacrimal drainage system.
Thermal Punctal Cautery for Chronic Ocular Surface Disease
In this video, permanent punctal occlusion is performed with high-temperature thermal cautery for the treatment of refractory ocular surface dryness, in this case due to graft-versus-host disease.
Endoscopic Ear Surgery – Incus Interposition for Traumatic Ossicular Discontinuity
A five year old with conductive hearing loss due to traumatic ossicular discontinuity presents for surgical management. Ossicular discontinuity with a fibrous union of the incudostapedial joint is identified. Transcanal Endoscopic middle ear exploration with incus interposition is performed.
DOI: http://dx.doi.org/10.17797/t0il7famg9
Editor Recruited By: Sanjay Parikh, MD, FACS
Upper and Lower Lid Internal Recession with Tarsal Graft Posterior Spacer
This video shows a combined upper lid internal recession and lower lid internal recession with placement of a tarsus posterior spacer graft in a patient with eyelid retraction due to thyroid eye disease.
Jones Tube Replacement with Endoscopic Endonasal Guidance
The procedure in this video demonstrates the removal and replacement of a malpositioned Jones tube with endoscopic endonasal guidance to ensure proper tube placement within the nose.
Glabellar Flap Reconstruction After Mohs Surgery
The procedure in this video demonstrates a bi-lobed glabellar flap reconstruction after Mohs micrographic excision of a basal cell carcinoma in the medial canthus of the eyelids.
Dermis Fat Graft Implantation into Anophthalmic Socket
Dermis fat graft implantation has been used for decades to augment orbital volume and surface area in patients with congenital anophthalmia as well as those suffering complications of secondary anophthalmia following enucleation. It is most commonly performed as a means of socket reconstruction in patients with an exposed or extruded orbital implant and to prevent socket contracture. In this video, a dermis fat graft is harvested from the buttock and implanted into an anophthalmic socket for treatment of exposure of orbital implant in the right socket of a patient who was status post enucleation in both eyes for painful blind eyes.
Suzanne K. Freitag, MD
Victoria Starks, MD
Zujaja Tauqeer
Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School