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Abstract #13193 Published in IGR 7-3
Transconjunctival suture adjustment for initial intraocular pressure control after trabeculectomy
Ashraff NN; Wells APJournal of Glaucoma 2005; 14: 435-440
PURPOSE: In an experimental human eye model of trabeculectomy, scleral flap suture adjustment allows predictable control of intraocular pressure (IOP). This approach had not previously been described in clinical use; we present a case series with the application of this technique. METHODS: A prospective, non-comparative interventional case series of consecutive patients undergoing trabeculectomy. Forty trabeculectomies were performed using a 3 mm x 4 mm scleral flap with two apical adjustable 10-0 nylon sutures under a fornix-based conjunctival flap. Intraoperatively the scleral flap sutures were tied tightly to appose the edges of the flap. All trabeculectomies were augmented with antimetabolite intraoperatively. On day one, patients with an IOP greater than 15 mmHg had their suture tension adjusted to lower their IOP to a target range (10 to 15 mmHg). Major outcome measures were IOP before and after adjustment and success at last follow-up (IOP ≤ 15 mmHg on no glaucoma medication and no clinically significant complications) without and with adjunctive needling. Other outcomes measured were postoperative complications, bleb needling, final bleb morphology, and visual acuity change from pre-operation to final follow-up. RESULTS: Average day one IOP was 14.8 mmHg (standard deviation (SD) 7.8). Fourteen patients had a day one IOP over 15 mmHg and underwent suture adjustment, lowering IOP to between 10 and 15 mmHg. (Mean post adjustment IOP was 10.7 mmHg (SD 3.6)). One patient had a conjunctival tear intraoperatively. Four patients had transient wound leaks. No patients had shallow anterior chambers. All but four had diffuse blebs at last follow-up. Success rate without any further surgical intervention was 75%, and success rate with adjunctive needling was 100%. The mean duration of follow-up was 6.3 months (range 1-12 months). CONCLUSION: The approach of tying scleral flap sutures tightly with transconjunctival adjustment of sutures if the IOP is greater than 15 mmHg on day one, allows excellent control of early postoperative IOP.
Dr. N.N. Ashraff, Manchester Royal Eye Hospital, Manchester, UK. nna32@eyetext.net
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
