For several years anterior-posterior lip sclerectomy with peripheral iridectomy has been our operation of choice for patients with uncontrolled chronic open angle glaucoma. The basic features of this procedure as we perform it are; (1) a long, widely dissected conjunctival flap, (2) opposing anterior and posterior lip sclerectomies done with a Holth punch, (3) a small peripheral iridectomy, (4) the injection of air beneath the conjunctival flap as it is closed, and (5) massage of air from the filtering bleb into the anterior chamber at the conclusion of operation.
Akinesia and anesthesia are established with a modified Van Lint lid block and a retrobulbar injection of 2 cc of 2% lidocaine with adrenalin containing 7.5 turbidity reducing (TR) units of hyaluronidase per cubic centimeter. The surgical technique is shown in the following series of drawings made from a motion picture of this procedure.
Attention to technical detail contributes to the
McPHERSON SD. Anterior-Posterior Lip Sclerectomy for Open Angle Glaucoma. Arch Ophthalmol. 1963;70(5):651-653. doi:10.1001/archopht.1963.00960050653013