How is globe fixation performed during trabeculectomy?

Updated: May 18, 2020
  • Author: Maria Hannah Pia Uyloan de Guzman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Globe fixation

To improve the exposure of the conjunctiva and limbus at the surgical site, the eye needs to be rotated in the direction opposite from the surgical site. An extremely cooperative patient under subconjunctival or topical anesthesia may be able to do this voluntarily, but in most cases a traction suture is needed.

A corneal traction suture does not puncture the conjunctiva, can be placed at various locations and can pull the eye in different directions depending on where it's anchored. However, corneal perforation is a possibility. To place a corneal traction suture, a 7-0 or 8-0 nonslippery suture (eg, silk or polyglactin) on a spatulated needle is passed through one half to two thirds of the corneal thickness parallel to the surgical site approximately 1-2 mm away from the limbus. The eye can then be pulled in the direction desired and the suture is anchored to the drapes using sterile tape or a clamp. Alternatively, the corneal traction suture can be placed near the inferior limbus and the suture looped through the inferior arm of a wire speculum lid retractor, which acts like a pulley.

The placement of a superior rectus traction suture is familiar to those who perform extracapsular cataract extraction. However, it is a blind procedure and could cause subconjunctival bleeding. Although the conjunctiva is perforated, a leak from the superior rectus traction suture site is extremely unlikely. To place a superior rectus traction suture, the superior rectus muscle (and the overlying conjunctiva) is grasped near its insertion and pulled away from the sclera using large-toothed forceps. A 4-0 or 5-0 nonslippery (eg, cotton or silk) suture on a round needle is then passed under the muscle and anchored superior to the eye to induce downward rotation of the globe.

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