Bleb Needling in Trabeculectomy Revision

In this video, a patient presenting with an obstructed trabeculectomy bleb has a revision performed using an ab externo bleb needling approach. The procedure begins by inserting a corneal traction suture for improved access to the scarred bleb and is followed by the insertion of an infusion canula providing a continuous source of balanced salt solution. A bent 25- or 27-gauge needle is then used to carefully disrupt the scar tissue within the bleb. The procedure concludes with the injection of mitomycin-c, an anti-fibrotic agent that aims to promote the longevity of the cleared bleb.

Ab Externo Trabeculotomy Performed via Illuminated Microcatheter

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.

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