File:Stab-Incision-Glaucoma-Surgery-A-Modified-Guarded-Filtration-Procedure-for-Primary-Open-Angle-2837562.f1.ogv

English: Superior conjunctiva is slid downwards over the cornea and a 2.8 mm bevel-up metal keratome is introduced 1.5 mm behind the limbus through the conjunctiva into superficial lamellar sclera to create a superficial scleral tunnel at a depth such that the blade is visualized through overlying sclera and conjunctiva. At the limbus, the blade is angulated more superficially to correspond to steeper corneal curvature and depth confirmed by a dimpling of the cornea. A 0.5 to 1 mm clear corneal tunnel is created and the AC entered in a horizontal plane. Downwards pressure on keratome is avoided while entering the AC. Viscoelastic is instilled into the AC and a 1 mm Kelly's Descemet's punch is used to punch the internal lip of the corneal section to create an ostium that is then extended posteriorly till the limbus. A peripheral iridectomy (PI) is done and the iris is then gently pushed back into the AC. A Simcoe cannula is inserted through the tunnel to wash out viscoelastic. Balanced salt solution is irrigated through the side port and leakage from the SIGS tunnel is assessed. End point looked for was a free flow of fluid on irrigation. Additional punches are taken in case of inadequate leak. The 2.8 mm conjunctival cut is sutured with a running 10-0 nylon suture. Additional BSS is injected through the side port to balloon the bleb.