Glaucoma Surgery

Glaucoma Surgery Glaucoma and Cataract Surgeon and Surgical Glaucoma "Fixer-Upper" at Moorfields, London

15/04/2026

2 month follow-up on an usual case of hypotony due to a ciliary body tear around a secondary IOL suture.

10/04/2026

Aniridic keratopathy or over-optimistic IOL placement?

There is no sign of aniridic limbal stem cell deficiency, the IOL is clearly in the cornea and if I tube the patient for glaucoma, that will be blamed for the corneal decompensation.

These IOLs should not be left in the imaginary sulcus in these patients.

07/04/2026

Chronic Hypotony after a sutured, scleral-fixated, secondary intraocular lens.

In this video, I describe the investigation and management of a case of a suspected ciliary body tear causing chronic hypotony after a sutured intraocular lens.

01/04/2026

Severe neovascular glaucoma with very high PAS is much less common since the advent of anti-VEGF treatment. This type of glaucoma is particularly suited to sulcus tube implantation because of the very deep sulcus that results and usually with a fixed dilated pupil.

However, it is unusual for an eye to require two non-valved drainage devlces as the function of the very ischaemic ciliary body is usually greatly reduced.

31/03/2026

Why did this tube re-erode rapidly after an initial repair with a robust donor patch graft?

These things are not random.

13/12/2025

Another in a seeming epidemic of scleral-fixated IOL-related hypotony cases. This patient developed chronic hypotony after a secondary sutured IOL. The UBM seems to show a ciliary body tear around the actual IOL suture. How can this be repaired? Not sure, but the UBM is certainly interesting.

10/12/2025

Diagnosis and Management of Another Case of Chronic Hypotony after a Yamane IOL Procedure

This patients was the second case of chronic hypotony after a Yamane IOL procedure that I've seen in a short time. In this video I demonstrate how the problem was diagnosed and managed with an introduction from cold and windy Ottawa.

#'hypotony

16/11/2025

Paul Glaucoma Implant Surgery - What To Do in the Case of Overdrainage

The Paul Glaucoma Implant, stented with a ripcord suture, provides more predictable intraocular pressure control in the early postoperative period than prevous non-valved glaucoma drainage devcies. However, all implants and ripcords vary slightly in drainage rate on the operating table. In this video, I describe how I adjust for overdrainage, while minimising the risk of overcompensation and subsequent high postoperative intraocular pressure.

01/11/2025

Preserflo MicroShunts occasionally erode through conjunctiva and become exposed. Although this happens in less than 1% of cases, a potential risk factor is tenting of the subconjunctival portion of the PreserFlo. One simple extra scleral bite when stenting with a ripcord, might potentially reduce the risk.

30/10/2025

When implanting a pars plana tube in an eye with a previous vitrectomy, I would always ask for a further vitrectomy as the vitreous needs to be shaved right to the base at the tube entry site. I would not have expected the same to be necessary with this anterior chamber tube, but it has also blocked with vitreous. Beware of assuming that a previous vitrectomy is sufficient.

29/10/2025

It is sometimes necessary to sulcus position a tube on the crystalline lens in a phakic eye. This is not as problematic is popularly believed. In this eye, the tube tip of this Paul Glaucoma Implant has accidentally ended up in contact with the lens throiugh a prior iridectomy. This is unlikely to cause problems.


23/10/2025

An Unusual Complication - Drainage of Orbital and Suprachoroidal Haemorrhage

This patient developed nonspecific malaise and orbital symptoms one week after a Paul Glaucoma Implant. Step by step explanation of the eventual surgical exploration and management.

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