So I do close the flap with 10 0 vicryl. I know others use nylon. I prefer vicryl because one of the things that you can run into with canaloplasty is the possibility of induced astigmatism.

Now here I’m using some Mastel needle drivers which are specially coated. And this coating just gives you wonderful grip and great control. In fact, I actually find many times I’ll just use these needle drivers and continue the tying process with them. So generally when I am suturing the superficial flap down, what I’ll do is I’ll suture the apex, and I’ll leave the first suture pretty loose. Because, remember, the eye is hypotenuse right now, and once I do bring the pressure up then these sutures will tighten. So I leave the apex pretty loose. But I do prefer not to inflate the anterior chamber until after I put down at least the apex suture. Just because until there’s something up against the trabeculo descemetic window, it’s very easy to blow out the window by inadvertently overfilling the anterior chamber. That’s why I just prefer to have the flap down before I fill the anterior chamber. And so you can either put one suture in, and then fill the anterior chamber, and then suture it through additional sutures if you want. Some people just throw one or three sutures; I tend to throw three to five. I’m actually holding onto the bridle suture, as I do think that that gives me a nice amount of control over the position of the eye as well as gives me good countertraction against the throwing of the suture.

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