How are sclerostomy (sclerectomy) and peripheral iridectomy 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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Answer

Answer

The posterior edge of the incision into the AC is then excised using a punch (eg, Kelly or Gass), blade, or scissors. When using a punch, ensure that the full thickness of the tissue is caught between the punch blades to avoid creating a lamellar or imperforate sclerostomy. The size of the sclerostomy depends on the amount of flow desired and the size of the scleral flap (refer to the Scleral flap dissection section above).

The iris is then grasped through the newly created opening using forceps and a peripheral iridectomy is cut using small, sharp scissors. The base of the iridectomy should be wider than the sclerostomy to prevent incarceration of the iris into the wound. The iridectomy should be small and superior enough so that it is hidden by the upper lid to avoid causing diplopia or glare. See the images below.

The peripheral iridectomy should have a broad base The peripheral iridectomy should have a broad base that is wider than the sclerostomy.
Photograph showing an eye after trabeculectomy. Th Photograph showing an eye after trabeculectomy. The peripheral iridectomy is ideal in its shape, size, and location.

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