Buphthalmos, Failed Surgery, 4th Operation

Management of buphthalmos is a great life long responsibility. When medication fails (it usually does) surgery has to be done. After every surgery, the surgeon has to ask himself - what shall I do if this one fails ? The techniques involving much dissection, if they succeed, well and good, if they do not succeed, there is a great problem at hand. Extensive surgeries/valves etc create much subconjunctival scarring and adherence of conjuncta to the sclera (making further dissection very difficult. This bilateral buphthalmos case was first operated by Transciliary filltration. Second time Microtrack filtration, third time repeat MTF.Initially very successful, but over months the filtration shut down due to scarring at the level of tenon capsule. Finally we thought of tenon capsule as the biggest problem. The patient is now 5 years old. This time it was planned to excise the tenon capsule around the area of filtration. Fugo blade was used to excise tenon capsule and to create a filtration track in the anterior chamber, close to angle recess. No bipolar cautery was ever used. The result is that even this time we could find the conjunctiva as freely mobile. We all need to share our buphthalmos surgery cases. Dr. Sameera in Pakistan has achieved great success with cases of buphthalmos.