Tips to Create Smooth Scleral Beds under Scleral Flaps: Theory and Preliminary Results

A surgical technique using a round-tip scarifier to create smooth scleral bed surfaces was postulated and performed on patients. During dissection in the right-handed direction, the blade should be rotated approximately 15° counter-clockwise around the axis of its handle from the bed-surface plane; the blade is then rotated clockwise for incision in the opposite direction. The handle is simultaneously set at approximately 15° from the scleral bed surface. When a thicker scleral flap is required during undermining, the blade is again relocated just posterior to the flap-bed angle, and dissection is resumed while the back edge of the blade is pushed into the bed more firmly. In each of 12 consecutive trabeculotomies performed by two surgeons, Schlemm’s canal was successfully identified using this technique.