title: Internal sclerectomy with an automated trephine for advanced glaucoma.
abstract: An automated trephine (trabecuphine) was used to perform an internal sclerectomy in seven glaucoma patients who were aphakic or had undergone previous filtering surgery that had failed or both. A patent fistula was achieved intraoperatively in all seven eyes. Postoperatively, six patients received subconjunctival injection of 5-fluorouracil (5-FI) once daily for an average of 8 days. Five of seven patients have retained a functional bleb and a controlled intraocular pressure (IOP) after surgery (follow-up, 4-24 months). The only intraoperative complication was hemorrhage from the sclerectomy site in a patient with aniridia that resulted in a 20% hyphema. The hyphema cleared quickly, and the bleb has remained functional with a pressure of 12 mmHg for 9 months. The trabecuphine makes it possible to perform a glaucoma filtering operation safely from within the anterior chamber. This technique minimizes conjunctival trauma in the filtration area. The absence of a conjunctival incision overlying the fistula simplifies the adjunctive use of antimetabolites such as 5-FU.
authors.affiliation: Department of Ophthalmology, University of Texas, Southwestern Medical Center, Dallas 75235-9057.
authors.forename: R H
authors.initials: RH
authors.lastname: Brown
authors.forename: M G
authors.initials: MG
authors.lastname: Lynch
authors.forename: D B
authors.initials: DB
authors.lastname: Denham
authors.forename: J M
authors.initials: JM
authors.lastname: Parel
authors.forename: P
authors.initials: P
authors.lastname: Palmberg
authors.forename: D D
authors.initials: DD
authors.lastname: Brown
mesh_terms: D002829:Choroid; D005128:Eye Diseases / Q000209:etiology; D005901:Glaucoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012599:Sclerostomy / Q000295:instrumentation*; D013525:Surgical Instruments; D014603:Uveal Diseases / Q000209:etiology; D014792:Visual Acuity