New filtering operation for open-angle glaucoma using a rolled corneo-scleral flap.

Method The conjunctival flap is prepared and reflected over the cornea by the method described by Scheie (I958) and the limbal area is exposed. With the blade of a scalpel, held perpendicularly to the limbal plane, a cut 3 mm. long is made in the limbal tissue (Fig. i a, b) concentric to the limbus more than half the depth of the sclera. At either end, two cuts I *5 mm. long are made perpendicular to the previous one to the same depth. A rectangular trap-door of corneo-scleral tissue, its base being attached to the scleral side, is dissected by a scalpel (Fig. ic). The anterior chamber is still intact. Bleeding points are gently controlled by a cautery. A double 8/o virgin silk suture is passed through the base of the trap-door from the anterior face (Fig. id) and then brought backwards through the very margin of the flap. By tying the two ends of the sutures the trap-door is rolled into a cylinder (Fig. ie). The anterior chamber is now opened with a scalpel at the very end of the scleral groove (Fig. I f). The posterior lip of the wound is firmly grasped with fine-toothed forceps and slightly pulled up. A second cut is made with the scalpel parallel to the first one, and slightly backwards, so that a narrow strip of limbal tissue is being held up by the forceps. With a few strokes of the scalpel at each side, the strip is completely separated. Through the narrow rectangular opening a peripheral iridectomy is done. The conjunctival flap is turned backwards over the rolled corneo-scleral flap and tied at the original cut, 8 mm. above the limbus, by a continuous 8/o suture (Fig. ig). A fine bleb is now seen, the posterior margin of which is elevated by the rolled flap. Restoration of the anterior chamber is not necessary. A drop of atropine sulphate i per cent. and a drop of steroid are instilled in the conjunctival cul-de-sac and the eye is closed with a pad. Postoperatively the pad is changed daily and atropine I per cent. drops and local steroid drops are applied.