Sir,
We read with interest the correspondence from Lindfield and co-authors about a method of placing a mitomycin-soaked sponge so that it would not get lost.1 We have published on this subject, which we agree is of importance.2 It seems likely that one reason why surgeons are reluctant to place sponges in a larger area, 6–10 mm posterior to the limbus, where they are most likely to cause aqueous drain away from the limbal area, and to lead to more diffuse blebs,3 is because the surgeons fear they will not be able to retrieve the sponge.
Our technique avoids taking these risks by using color-tailed sponges (Codman Surgical Patties, available from Codman, Raynham, MA, USA) for antimetabolite application. We like our technique because it does not require an extra step, it is safe and inexpensive, and there is no possibility of the suture becoming detached from the sponge. It is surprising to us that the idea of using a technique to prevent loss of mitomycin-soaked sponges in trabeculectomy does not seem to have caught on. There is no down side, and there are many advantages.
References
Lindfield D, Jutley G, Griffiths M . Trabeculectomy pearls of wisdom; mitomycin-soaked pledget ‘necklace’ suture. Eye 2010; 24 (7): 1307–1308.
Melo AB, Spaeth GL . A new, safer method of applying antimetabolites during glaucoma filtering surgery. Ophthalmic Surg Lasers Imaging 2010; 41 (3): 383–385.
Onol M, Aktaş Z, Hasanreisoğlu B . Enhancement of the success rate in trabeculectomy: large-area mitomycin-C application. Clin Experiment Ophthalmol 2008; 36 (4): 316–322.
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Melo, A., Spaeth, G. Trabeculectomy pearls of wisdom; mitomycin-soaked pledget ‘necklace’ suture. Eye 26, 173–174 (2012). https://doi.org/10.1038/eye.2011.281
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DOI: https://doi.org/10.1038/eye.2011.281
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