Double Tunnel Glaucoma Shunt with Mitomycin C, 2024 Update

This video demonstrates a modification of the double tunnel glaucoma shunt procedure to accomodate changes in USA regulations regarding the use of mitomycin C in surgery. The mitomycin excess is injected into a small bottle of irrigation solution and the 20 micrograms of mitomycin is injected into the subconjunctival space prior to starting the procedure thereby using the mitomycin in a "closed" environment and hopefully satisfying the new USP800 guideline. A 2.5 minute waiting time is needed for full mitomycin binding and during this time other shunt prepartory steps are performed to maintain surgery efficiency. This is not a sponsored video and the author has no financial relationships with any product mentioned. New to the double tunnel technique is the addition of the Jarabak orthodontist plier for bending the 22g needle to the proper shape.