A temporary dissecting seton for trabeculectomy: delayed re-creation of the glaucoma filtering sclerostomy and bleb

Presented is a new surgical technique to re-create the entire filtering pathway 2 weeks following trabeculectomy. The dissecting seton is a suture loop of 9-0 nylon, silk, or polypropylene placed in the potential outflow space of the sclerostomy and bleb area during trabeculectomy. The seton is pulled out at the slit lamp, under topical anesthesia, 1 to 3 weeks after the initial surgery in order to re-create the filtration pathway. By pulling on the seton, a cheesewiring dissection severs newly formed fibrovascular tissue that may have occluded or constricted the previously created aqueous outflow tract at any point(s). Because of the significant time delay, the reopened filtration pathway is, for the first time, filled with flowing aqueous of nearly normal composition under a well-healed conjunctiva as a result of a nearly normally functioning ciliary body in a nearly quiet eye. Delayed postoperative re-creation of the bleb with the dissecting seton may be combined with other management techniques such as 5-fluorouracil subconjunctival injections, suture cuttings, bleb massage, etc. This technique has been used in nine cases with follow up ranging from a few weeks to 1 year. All were trabeculectomies with phacoemulsification and intraocular lens implantation. Both initial placement and subsequent handling of the dissecting seton appear to be safe, quick, easy, and inexpensive. Complications or failures have all been minor and easily managed.