DATE OF OPERATION: MM/DD/YYYYY
PREOPERATIVE DIAGNOSES:
1. Open angle glaucoma.
2. Exposure of glaucoma tube.
POSTOPERATIVE DIAGNOSES:
1. Open angle glaucoma.
2. Exposure of glaucoma tube.
OPERATION PERFORMED:
1. Revision of glaucoma tube.
2. Scleral graft, right eye.
SURGEON: John Doe, MD
ANESTHESIA: Monitored anesthesia care.
INDICATIONS FOR OPERATION: Glaucoma with exposure of glaucoma tube.
FINDINGS AND DESCRIPTION OF OPERATION: The patient was given a local anesthetic in the holding area as follows. After intravenous sedation, 6 mL of 2% Xylocaine with epinephrine were injected in the form of a modified Van Lint block, followed by a peribulbar injection of 3 mL of 4% Xylocaine and Wydase. A Honan balloon was applied at 30 mmHg pressure and left in place for 15 minutes.
The patient was taken to the operative suite where the Honan balloon was removed. She was prepped and draped in the standard fashion for ocular surgery. The eyelids were parted with a Maumenee-Park lid speculum. A 4-0 silk superior rectus bridle suture was placed. The eyelid was infraducted. A peritomy was performed at the limbus, supratemporally. Conjunctivae and the previously placed scleral graft were very adherent to the globe and dissection was carried out using a 69 Beaver blade. Conjunctivae and Tenon’s, and the underlying scleral graft were dissected as a single plane and carried posteriorly to a point just posterior to the tube perforation through the conjunctivae. Relaxing incisions were created nasally and temporally. Hemostasis was obtained with mild electrocautery. The tube was isolated. Two 8-0 nylon sutures were used to bury the tube into the underlying sclera.
A specimen of pericardium was obtained and rehydrated. A 5-mm graft was cut free, and this was sutured over the tube with four 7-0 Vicryl sutures. Conjunctiva was closed at the limbus with 7-0 Vicryl. The area of the previous perforation was then closed with an 8-0 Vicryl suture that was then dressed with atropine 1% solution and Maxitrol ointment. Then, 2 mg of Decadron were injected subconjunctivally in the inferotemporal quadrant. That was dressed with mild pressure patch and shield. The patient tolerated the procedure well. There were no complications. She was taken to the discharge area in stable condition.
