VT122 : Is Reverse, Right?

Dr.SWATHI VALLABH, Dr.Sirisha Senthil

Tube insertion into the anterior chamber can be one of the most challenging steps in a paediatric implant surgery. Ideally, anterior placement of the tube is not preferred, as it has complications of tube exposure and endothelial tube touch associated with it. A posterior placement of the tube about 3 mm from the limbus is preferred as the above complications are less. The most common difficulty faced during tube insertion is the misdirection of the tube into the sulcus even when the hard needle entry is made in the anterior chamber. The bevel up position allows the sharper tip of the tube, which is posterior, to pierce the eye and pave the way for the rest of the tube. Inadvertent posterior placement in sulcus is common. A simple solution to this problem is to reverse the tube and insert in the bevel down position. As the sharper tip is now anterior, the entry is into the AC rather than the sulcus. Once inside the eye, the tube can be rotated into the bevel up position again.