Fugo blade as Atwal balanced approach (ABA) for glaucoma - part I

Dr Amar Atwal, surgeon from the Atwal Surgical Center in Buffalo, New York, is one of the most promissing surgeons on the east coast of the USA. Dr Atwal is thought as surgical leader and pioneer in avantgarde and safe surgical procedures. Since 25 years has Dr Atwal performed most available glaucoma procedures. The Singh Filtration (TCF) was modified by him in order to provide to maximalise the safety and control and minimalise the consequences such as a lack of post op flat anterior chambers...in that case he has developed the Atwal Balanced Approach (ABA). The ABA procedure consists of a mini trabeculectomy (filtration from the anterior chamber) with TCF (filtration from the posterior chamber). That trabeculectomy procedure is much faster, safer and controlled than traditionall blunt trabeculectomy. A posterior TCF chamber is, on the way of plasma trabeculectomy, created in order to drain fluid from the posterior chamber of the eye. The viedeo by Professor Marlene Moster also shows the combination of antero-posterior inter chamber aqueous filtration. During ABA procedure balanced draining of fluid is allowed as well from behind the iris, as from the front of the iris. The larger bore TCF is insurance, which enables to reach the pressure behind the iris always lower that in the anterior chamber. According to is the force vector behind the iris always too low to push the iris forward, independend on IOP. The lack after surgery is flat, there is no need stitches down the trab flap nor a need to create a water tight conjunctival closure, 2 or 3 conjunctival sutures are enough. In this Dr Atwal shows that ABA filtration is ideally suited to be combined with standard phacoemulsification cataract surgery.