referring to fig1 - 6 , prior to surgery , the device is constructed in the operating room under sterile conditions . an oval template 10 is fashioned out of heavy sterile paper and measures approximately 25 mm in length and 10 mm in width . this is then superimposed on a thin silicone sheet 12 , and the oval paper stencil is traced with a beaver blade forming a corresponding silicone oval 14 . the tube is secured with a 7 - 0 prolene 18 to the silicone sheet near the destined inferior proposed tip of the device . the tube wall is grasped with tying forceps so that two additional side exit ports 20 of 1 mm can be cut out . the oval silicone sheet is then folded like a taco , and the open edges sutured with running and intermittent locking 7 - 0 prolene forming the shunt device 22 . the conjunctiva is incised anterior to the superior rectus and a horizontal ( medial or lateral ) muscle . this is done either temporally or nasally depending on whether the device is to be placed temporally or nasally . tenon &# 39 ; s capsule is separated from the underlying sclera using curved scissors ( stevens ). a 0 silk traction suture is then placed under the superior rectus and a 0 green suture under the lateral or medial rectus ( fig7 ). cotton swabs are soaked in 400 μg / cc of mitomycin c . the swabs are inserted in two quadrants between the recti muscles for 2 minutes ( thin tenons ) or 4 minutes ( thick tenons ). the shunt device 22 is then inserted , sutured end toward the limbus , under the horizontal rectus and is then anchored to the sclera with 7 . 0 prolene , first at 10 or 2 o &# 39 ; clock and then inferiorly at 5 or 7 o &# 39 ; clock . the tip of a colibri forceps is used to slip under the middle of the superior rectus tendon 26 anteriorly and then cauterized in order to create a 1 mm opening , the silastic tube 16 pulled through this opening and then laid aside . a trabeculectomy type sclera flap 28 , three - quarters thickness , is created with a crescent knife . a short 25 gauge needle 30 doubly bent on a 2 cc viscoat syringe is slowly introduced into the posterior chamber through the solera 2 mm posterior to the hinge of the flap 28 ( fig8 ). the needle is gently tilted toward the iris 32 in order to identify its location . viscoat is then injected , forcing the iris toward the cornea and thus creating a protected surgical space to introduce the tube between the posterior surface of the iris and the lens . the silastic tube 16 is draped over the corneal limbus and cut with a vannas scissors , allowing the bevel to face the back of the iris , and projected into the posterior chamber 3 - 4 mm . the tube 16 is then introduced into the sclera opening 28 such that the tube tip extends just beyond the pupillary margin ( fig9 ). the sclera is depressed with smooth forceps just posterior to the entry site of the silastic tube . this flattening of the sclera helps guide the tube anteriorly into the posterior chamber instead of posteriorly into the vitreous . the tube 16 is secured to the sclera with a 7 - 0 prolene suture 1 mm anterior to the superior rectus tendon so that the suture is not covered by the flap . the suture is tied tight enough to flatten the tube , restricting but not blocking the outflow and to prevent tube motility . the trabeculectomy flap is then closed over the tube with two 7 - 0 vicryl sutures , allowing 1 - 2 mm of exposed sclera bed on either side of the flap such that the flap is not compressing the tube ( fig1 ). the intraocular pressure ( iop ) can be restored to normal by either injection of viscoat , into the anterior chamber or injection of balanced salt solution into the vitreous cavity . the conjunctiva is then closed with running locking 7 - 0 vicryl . decadron and vancomycia is injected subconjunctivally , and antibiotic solution is used to irrigate the surface of the eye . when the eye moves , the horizontal rectus compresses the fluid filled “ taco ” such that fluid is pumped from the posterior chamber through the tube 16 and into the orbit of the eye . for example , if the device is placed under the lateral rectus muscle of the left eye and if the eye moves nasally , the fluid is compressed by the muscle . thus the fluid that enters the tube and “ taco ” by the higher intraocular pressure is further pushed into the orbit by the compression of the muscle . this dual mechanism avoids the build - up of intraocular pressure that would otherwise occur in the glaucomatous eye . thus , the fluid is removed from the eye avoiding the build - up of pressure which would otherwise occur . the end of the tube 16 distal from the shunt device 22 may be dyed a dark color , such as blue or black ( fig1 ). to prevent overflow into the orbit of aqueous fluid , the lumen of tube can be restricted by a 9 - 0 black nylon which can be opened with a laser when the intraocular pressure rises . control of fluid overflow can also be restricted by utilizing a dark dyed tube with a 50μ opening permitting a limited aqueous fluid to escape . in the event that the tube is closed or partially closed due to blood clots or other reasons , the darkened end of the tube can be targeted by a laser beam and at least one opening can be formed in the tube 16 to overcome the blockage . obviously , many modifications may be made without departing from the basic spirit of the present invention . accordingly , it will be appreciated by those skilled in the art that within the scope of the appended claims , the invention may be practiced other than has been specifically described herein .
an implant for use in surgery for glaucoma of an eye having an oval plastic piece to which a tube is attached . the oval is wrapped as a taco enclosing the tube . the oval is placed via an incision in the conjunctiva to allow the device to be placed under the lateral or the medial rectus muscle . the tube is disposed in a sceral flap in the eye . a surgical method using the device is disclosed .