**3. Intracameral suture**

Intracameral sutures have been in use for a long time, mostly in relation to intraocular lens implants and trauma surgery. The tracks they make and the space they occupy are devoid of complications.

**4.** A 1 cm + long straight needle carrying 10 zero prolene is passed through the upper part of the anterior chamber. The entry and the exit points are in the sclera, about 1 mm from the limbus. For leaving the suture permanently, the needle is returned parallel and close

Minimally Invasive Glaucoma Surgery – Strategies for Success

http://dx.doi.org/10.5772/54421

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**5.** A conjunctival hole is made at 10 O' clock close to the limbus. 0.1 to 0.2 ml of MMC 0.01% or 0.02 % is injected through a 30 gauge cannula, so as to raise a balloon. The fluid is spread

**6.** MTF is done with a 100 micron Fugo blade tip is set at highest energy, which ablates a 250

**7.** An air bubble is placed in the anterior chamber. NaHa can also be added to the anterior

If a temporary intracameral suture is to be placed it is done as follows: The prolene carrying needle is passed through the anterior chamber, but is not pulled out on the other side, till MTF track has been made. The suture is tied over the limbus. The suture is stretched close and under the internal opening of the MTF track. This suture can be easily lifted and cut af‐ ter 2-3 weeks, when the anterior chamber has become stabilized.Both variations of intracam‐

The goal is to create resistance around the filtration track by injecting a viscoelastic material in the anterior chamber or subconjunctivally. NaHa is one such material. Its effectivity is dif‐

The other material is Healaflow- cross linked sodium hyaluronate, a material of high viscos‐ ity with an ability to stay in place for a long time and getting resorbed slowly. It has been used in all kinds of glaucoma operations as an adjunct since 2008.It has been used in the scleral space,under the scleral flap and under the conjunctiva. Healaflow is reticulated i.e. its architecture is like a network.This makes it a good space former and it has a long life span in

The unique properties of Healaflow, make it particularly suitable as an adjunct in MTF. Un‐ der the conjunctiva, it is used as a "liquid cushion" against excessive flow during the first days and weeks after surgery. It is also our understanding that Healaflow presence under the conjunctiva shall retard the entry of aqueous in to the conjunctival lymphatics, create a sort of back pressure, that may prevent a flat anterior chamber. This reduces/prevents inter‐

to the first route. The suture is tied and cut short and the knot buried.

MMC can be placed under the conjunctiva, either before or after doing MTF.

out by the length of the cannula. Wait for 2 minutes.

chamber to provide better stability.

eral suture are seen in the following film:

The procedure is somewhat cumbersome.

**4. Viscoelastic resistance**

ficult to perceive beyond 4-5 hours.

situ.

nal iris block.

http://www.youtube.com/watch?v=iNk\_AsC-SEw

micron track.

In connection with Microtrack filtration surgery, we thought of using intracameral sutures to prevent the iris from moving forward and closing the internal opening.The idea is to have a 10 zero polypropylene suture or a 30 micron stainless steel wire stretched in front of the iris periphery in the area of the MTF track.

**Figure 14.** Transcameral suture is passed once towards the left and then it is returned to the right. The entry point is about 1 mm from the limbus in the sclera.Air is injected after MTF.

Steps of operation:


MMC can be placed under the conjunctiva, either before or after doing MTF.

If a temporary intracameral suture is to be placed it is done as follows: The prolene carrying needle is passed through the anterior chamber, but is not pulled out on the other side, till MTF track has been made. The suture is tied over the limbus. The suture is stretched close and under the internal opening of the MTF track. This suture can be easily lifted and cut af‐ ter 2-3 weeks, when the anterior chamber has become stabilized.Both variations of intracam‐ eral suture are seen in the following film:

http://www.youtube.com/watch?v=iNk\_AsC-SEw

The procedure is somewhat cumbersome.
