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Purpose: Recent studies show that using a traction suture through the superior rectus muscle in filtering glaucoma surgery is associated with a lower success rate compared with a corneal traction suture. A 12 o'clock corneal traction suture combined with a fornix-based approach may distort the architecture of the scleral flap. Methods: In a new technique, a corneal 6 o'clock traction suture is placed near the limbus, thus avoiding any disturbance at the site of filtering surgery. The suture is passed underneath a notched solid-bladed lid speculum that pushes the suture deep into the inferior fornix and rotates the eye downward. Results: In 20% a hemostat was needed to fix the suture to the surgical drape. During a period of 26 months and 412 trabeculectomies only 1 corneal perforation in an adult patient with congenital glaucoma and thin cornea was seen. Conclusion: The 6 o'clock traction suture with the glaucoma lid speculum is easy to learn and safe.
T. Klink. Department of Ophthalmology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany. klink_t@klinik.uni-wuerzburg.de
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)