A new 6 o'clock traction suture technique for glaucoma filtration surgery

Recent studies show that using a traction suture through the superior rectus muscle in filtering glaucoma surgery is associated with a lower success rate compared with a corneal traction suture. A 12 o'clock corneal traction suture combined with a fornix-based approach may distort the architecture of the scleral flap.

In a new technique, a corneal 6 o'clock traction suture is placed near the limbus, thus avoiding any disturbance at the site of filtering surgery. The suture is passed underneath a notched solid-bladed lid speculum that pushes the suture deep into the inferior fornix and rotates the eye downward.

In 20% a hemostat was needed to fix the suture to the surgical drape. During a period of 26 months and 412 trabeculectomies only 1 corneal perforation in an adult patient with congenital glaucoma and thin cornea was seen.

The 6 o'clock traction suture with the glaucoma lid speculum is easy to learn and safe.