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Year : 2019  |  Volume : 57  |  Issue : 4  |  Page : 337

Large scleral buttonhole-intraoperative surprise


Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission18-Aug-2019
Date of Acceptance17-Oct-2019
Date of Web Publication26-Dec-2019

Correspondence Address:
Dr. Vijayalakshmi A Senthilkumar
Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_74_19

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How to cite this article:
Senthilkumar VA, Rajendrababu S. Large scleral buttonhole-intraoperative surprise. TNOA J Ophthalmic Sci Res 2019;57:337

How to cite this URL:
Senthilkumar VA, Rajendrababu S. Large scleral buttonhole-intraoperative surprise. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Aug 14];57:337. Available from: http://www.tnoajosr.com/text.asp?2019/57/4/337/273980



A 65-year-old male with pseudoexfoliation glaucoma, 4 days post-combined small incision cataract surgery with trabeculectomy, operated outside referred for shallow anterior chamber (AC). At presentation, Best-corrected visual acuity was 2/60 in LE and IOP was 2mm Hg. Slit lamp examination revealed diffuse bleb with flat anterior chamber both centrally & peripherally with a negative Siedels test in LE. Bscan showed 360 degree shallow choroidal detachments. The diagnosis of over filtering bleb was made, and flap resuturing was planned. Intraoperatively, large scleral buttonhole of 2 mm × 1 mm was seen exactly over the ostium [Figure 1]a with a poorly created thin scleral flap. A partial-thickness corneal patch graft of 5 mm × 4 mm size covering the buttonhole and flap area with a tight tamponade 10-0 nylon suture was placed [Figure 1]b. One month postoperatively, LE vision improved with well-formed AC [Figure 1]c. We report this to emphasize the significance of creating an adequate flap thickness as well as meticulous handling of flap while performing trabeculectomy to avoid flap-related complications postoperatively. The surgeon must defer proceeding with trabeculectomy if flap creation is not successful. Hypotony is a sight-threatening complication if not diagnosed at an early stage. Early intervention in our patient prevented irreversible vision loss due to hypotony.[1],[2],[3]
Figure 1: (a) Large scleral buttonhole 2 mm × 1 mm was seen exactly over ostium, with poorly created triangular scleral flap with corneal edema, descemet membrane folds. (b) Partial corneal patch graft of 5 mm × 4 mm size covering the buttonhole and thin flap area with a tight tamponade 10-0 nylon suture. (c) Clearing corneal edema with well-formed anterior chamber with patch graft in situ

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bochmann F, Kaufmann C, Kipfer A, Thiel MA. Corneal patch graft for the repair of late-onset hypotony or filtering bleb leak after trabeculectomy: A new surgical technique. J Glaucoma 2014;23:e76-80.  Back to cited text no. 1
    
2.
Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153:804-140.  Back to cited text no. 2
    
3.
DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002;120:297-300.  Back to cited text no. 3
    


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