case_images: PMC8294996_01
case_images: (a) shows scleral thinning evident after conjunctival dissection (white arrow). (b) shows TutoplastTm in place covering the bed of the plate (black arrow) and the tube (red arrow). (c) shows the plate and the tube in place over the TutoplastTm. (d) shows postoperative slit-lamp picture of the tube in place with over lying TutoplastTm.
case_images: CRIOPM2021-6698919.001.jpg
case_images: PMC8294996_01_CRIOPM2021-6698919.001.jpg
case_images: fig1
case_images: California, USA) GDD over the TutoplastTm ("middle tube layer of sandwich"), and the plate was then sutured successfully to an area of sclera that did not show thinning on visualization using 9/0 Prolene suture on a spatulated needle. This was to ensure the plate was secured in place and minimize its movement. The tube was fixed to the TutoplastTm to avoid perforating the sclera as the rest of the anterior sclera showed bluish discoloration and thinning. The GDD lumen was occluded via a 3/0 Supramid suture to avoid postoperative hypotony, and the tube was inserted into the anterior chamber through a superotemporal limbal tunneled incision. The free end of the Supramid suture was then tucked to the inferior fornix. Another double layer of pericardial TutoplastTm was glued over the tube, and the conjunctiva was placed over the graft ("top layer of patch graft tube sandwich"). Conjunctival closure was achieved via suturing and gluing at the limbus only (Figure 1).