The following transcript has been edited for clarity.
Hi everyone, thank you so much for joining us here today. My name is Shivani S. Kamat, MD. I am here at the American Academy of Ophthalmology (AAO) in New Orleans. I just moderated a session that was titled the Glaucoma Fellowship Director Survival Guide, which was designed to give practical tips and tricks, particularly for glaucoma surgery. I am joined by Erin A. Boese, MD, who is the glaucoma fellowship director at the University of Iowa. Dr. Boese, can you tell us about your talk?
Erin A. Boese, MD: Thank you so much. I focused my talk mostly on tips and tricks when it comes to tubes, especially when it comes to suturing. But I started out with a piece of advice—unrelated to tubes, but applicable whether you are a glaucoma surgeon or a surgeon in general—that I got from my dad, Lee Alward, MD, who was also a glaucoma specialist. And that was, “Don’t do anything lazy or stupid.” Or I guess he phrases it as a question, like, “Did I do anything lazy or stupid?” With the caveat of we all have really hard days in the OR—complications, difficulties—so when you reflect upon that day or that case, you ask yourself that question. And if you did, you need to really make sure that you learned a lot from that, and that it never happens again. But most of the time, no, you didn’t do anything lazy or stupid. And the nice thing about that question is that if the answer is no, you can kind of forgive yourself and move on. And to me, that was a very valuable lesson and something that I take with me every single day.
The rest of the talk was focused on 3 surgical suturing tips when it comes to tubes. A lot of the time, I spoke about a tip I learned from Josh Stein, MD, when I was in my fellowship. And it’s a way of really helping control the eye pressure with nonvalved tubes— Baerveldts and ClearPaths—in those 6 to 8 weeks while you’re impatiently waiting for them to open. And what he taught me was to use a 10-0 Vicryl to make the fenestrating slit, but then also make a horizontal mattress where the exposed loop of that mattress sutures on the peripheral cornea. And then you can apply tension with that suture to that fenestrating slit to really adjust the flow through that fenestration, which often gives you much more pressure lowering and much more pressure control in those weeks after the surgery as you're waiting.
Then a few other tips, like using a 21-gauge cannula to help tuck tails when you’re suturing on a plate, and then little tricks to help relax the conjunctiva to really make sure that the sutures that you do throw have a chance of actually working—that you’re optimizing the tissue environment that you’re working in.
Dr. Kamat: I love the little pearl about turning a suture because I think, particularly in training, they’re trying to just get through the case, if it’s a tough case. Her example was a suture that had largely been turned, but there was a little tail still sticking out of the plate eyelet, and it just kind of tied the whole theme together, which is you don’t have to be the very best at everything, but you always have to do your best. And I think that we, as fellowship directors, really have to strive to remind not just the trainees, but even ourselves that we're always learning and we always have to do our best for our patients.
Dr. Boese: Reflecting on all of those things to make sure you’re doing your best.
Dr. Kamat: Yes. Thank you so much for joining us today! GP