3055: glaucoma seton with stent suture
Managing early post-operative hypotony is a primary challenge when placing non-valved glaucoma drainage devices, and this elegant technique utilizes an intra-luminal stent suture to restrict initial aqueous outflow. By threading a 5-0 polypropylene suture directly inside the lumen of the seton tube, the surgeon effectively occludes flow during the initial weeks required for a fibrous capsule to encapsulate the plate. Leaving a section of the suture extended subconjunctivally allows for straightforward, non-invasive removal in the clinic once aqueous suppression is tapered or intra-ocular pressure begins to rise. Additionally, routing the tube through a long intra-scleral tunnel provides robust tissue coverage, mitigating the risk of late tube exposure without relying solely on pericardial or scleral patch grafts. Watch the video to analyze the precise placement of the intra-luminal stent suture and the creation of the intra-scleral pathway. What is your go-to strategy for preventing early hypotony in non-valved glaucoma seton implants: intra-luminal stents, Vicryl ligatures, or a combination of both? Please comment your pearls below.
