Clinical Study Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma Soosan Jacob, 1 Michele Figus, 2 Dhivya Ashok Kumar, 1 Ashvin Agarwal, 1 Amar Agarwal, 1 and Saijimol Areeckal Incy 1 1 Dr. Agarwal’s Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, India 2 University of Pisa, 56126 Pisa, Italy Correspondence should be addressed to Amar Agarwal; dragarwal@vsnl.com Received 18 December 2015; Revised 14 March 2016; Accepted 20 March 2016 Academic Editor: Ozlem G. Koz Copyright © 2016 Soosan Jacob et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To describe a modifed guarded fltration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG). Methods. Tis prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual feld defects). Afer sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superfcial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5–1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet’s punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fuid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41 ± 5.54 mmHg and mean postoperative IOP was 16.47 ± 4.81 mmHg ( = 17). Mean reduction in IOP was 38.81 ± 16.55%. Tere was signifcant reduction of IOP ( < 0.000). 64.7% had IOP at fnal follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted afer SIGS in interim follow-up (14.18 ± 1.88 months). 1. Introduction Conjunctival dissection is an important step in glaucoma fltering surgery [1, 2]. Decreasing the intraoperative con- junctival manipulation may be expected to lead to less subconjunctival fbrosis and better aqueous drainage in the long term [3–5]. An accepted method of maintaining aqueous drainage has been conventional trabeculectomy where, afer raising a conjunctival fap, an artifcial channel is made between the anterior chamber and the subconjunctival space by means of a scleral fap [1]. Reduction of intraocular pressure (IOP) has been known to be sustained by this channel over a period [6–9]. In this paper, we have presented a modifed technique of trabeculectomy for primary open angle glaucoma (POAG) where a scleral tunnel has been used with decreased conjunctival dissection. Tis technique was described by one of us (SJ). 2. Materials and Methods Tis prospective interventional case series was carried out at Dr. Agarwal’s Eye Hospital and Eye Research Centre, Chennai, India. Institutional review board (IRB) approval was obtained and the procedure conformed to declaration of Helsinki. Informed consent was obtained from all patients. Preoperative visual acuity was measured with Snellen acu- ity charts, IOP by Goldmann applanation tonometer, and anterior chamber depth by optical coherence tomography. Patients with primary open angle glaucoma of age 40 to 70 years, IOP more than 21 mmHg, and visual feld defects on automated perimetry and who were willing for follow-up were included afer informed consent. Patients with previous uveitis, conjunctival scarring, angle closure glaucoma, previ- ous trabeculectomy, and poor visual acuity in fellow eye and one eyed patients were excluded. Te follow-up visits were on day 1, day 7, 1 month, 3 months, 6 months, and so on. Hindawi Publishing Corporation Journal of Ophthalmology Volume 2016, Article ID 2837562, 7 pages http://dx.doi.org/10.1155/2016/2837562