The JFC Method: A Proof-of-Concept Report on the Surgical Technique and Initial Feasibility of a Novel Flanged-Cord Temporary Occlusion for Non-Valved Glaucoma Drainage Devices.

Purpose: To describe the design and initial proof-of-concept of the Japanese Flanged Cord (JFC) method, a novel technique for temporary intraluminal occlusion of non-valved glaucoma drainage devices (GDDs) to prevent postoperative hypotony. Patients and Methods: This technical report describes a new occlusion method utilizing a 5-0 polyvinylidene fluoride (PVDF) or polypropylene monofilament suture. A terminal flange is created on the suture using thermal cautery, functioning as an intraluminal plug. This flanged cord is inserted into the GDD tube to block aqueous flow without tube ligation. The external end is secured subconjunctivally for later removal. The clinical feasibility of this technique was evaluated in a single patient with refractory glaucoma undergoing Ahmed ClearPath (New World Medical Inc. CA, USA), implantation. Results: In this index case, the JFC method provided secure, watertight occlusion of the GDD tube. The intraluminal obturation mechanism eliminated the need for external ligation, thereby avoiding potential tube damage such as kinking or laceration. Postoperatively, intraocular pressure was well-controlled without hypotony. The cord was removed atraumatically at the slit lamp at the surgeon's discretion, establishing flow without complications. Conclusion: The JFC method demonstrated initial clinical feasibility as a potential alternative to traditional external ligation techniques. By avoiding external compression and offering surgeon-controlled flow initiation, this technique may address key limitations of current non-valved GDD surgery. However, as these findings are based on a single-case report, further studies in larger cohorts are strictly required to validate its safety and long-term efficacy.