Münster standard: modified Paul® implantation in a condition following Preserflo® MicroShunt implantation. Video article

Abstract

The aim of this surgical technique is the modified placement of aPaul® implant (Fa. Advanced Ophthalmic Innovations, Singapur) in eyes after failure of Preserflo® MicroShunt (Fa. Santen, Osaka, Japan) implantation for the best possible adjustment of the intraocular pressure. The technique presented here is intended for patients suffering from more complex glaucomas, which were unsuccessfully previously treated with a Preserflo® Microshunt (Santen Inc.). The special feature of the Münster standard is the choice of the surgical field and the waiver of a further tunnel placement. The patients receive a Paul® implant in the same quadrant as the previously inserted Preserflo® MicroShunt implant (superior temporal). The latter is explanted after preparation of the conjunctiva and priming of the Paul® implant with aProlene 6.0suture and fixation of the plate. In order to carry out the implantation of the Paul® tube through the existing 25-gauge tunnel, the latter is dilated laterally with an iris spatula under positioning of the anterior chamber. Asurgical video, which is available online, shows the surgical technique in detail. ADVANTAGES OF THE MüNSTER STANDARD: The superior temporal surgical access promises easier handling. The fact that there is no need for anew tunnel effectively saves surgery time and is expected to reduce endothelial cell loss as only one tube remains in place in comparison to two anterior chamber tubes.