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Abstract #18066 Published in IGR 9-2
The use of a 'cheese-wire' suture in trabeculectomy
Prem-Venkatesh ; Ramamurthi S; Montgomery DMBritish Journal of Ophthalmology 2007; 91: 500-504
AIM: To report a preliminary study on the safety and efficacy of the use of a cheese-wire suture in trabeculectomy. Patients and methods: The case notes of 32 eyes of 25 patients with medically uncontrolled glaucoma who underwent trabeculectomy with cheese-wire suture at Stobhill Hospital, Glasgow, UK, between July 2001 and September 2002 were studied retrospectively. Diagnoses included primary open angle glaucoma (n = 24), normal tension glaucoma (n = 3), angle closure glaucoma (n = 2), ocular hypertension (n = 1), angle recession glaucoma (n = 1) and combined mechanism glaucoma (n = 1). The mean presenting intraocular pressure (IOP) was 29.5 mmHg and mean intraocular pressure before operation was 23.5 mmHg. OUTCOME MEASURES: Success was defined as lowering of IOP by at least 15% compared with IOP before removal. RESULTS: A total of 20 eyes (62%) underwent removal of the cheese-wire suture. Seventeen eyes (85%) underwent removal for therapeutic reasons (failing/failed blebs) and three eyes (15%) underwent suture removal as the suture loops were exposed. The timing of removal was between 2 weeks and 12 months following surgery. A successful outcome was seen in 12/17 (70%) eyes in the eyes that had therapeutic suture removal. Fifteen eyes had undergone previous surgical interventions (trabeculectomy n = 12, extracapsular cataract extraction n = 1 and laser peripheral iridotomies n = 2). Mean IOP before removal was 23.66 mmHg and mean IOP immediately following removal was 11.33 mmHg. Of the 32 eyes that underwent trabeculectomy with cheese-wire suture, 24 eyes had intraoperative mitomycin C and one eye had 5-fluorouracil. The remaining seven eyes did not have any antimetabolites. Early complications related to the surgical procedure included conjunctival haematoma in one eye (3%), corneal abrasion in one eye (3%), wound leak in five eyes (15%), shallow anterior chamber in one eye (3%), hyphaema in six eyes (18%), choroidal effusion in six eyes (18%) and raised IOP in two eyes (6%). Late complications of suture exposure occurred in three eyes (9%). Complications related to removal of the cheese-wire suture included suture breakage in two eyes (10%), hypotony in one eye (5%) and transient hyphaema in one eye (5%). CONCLUSION: The use of cheese-wire suture in trabeculectomy appears to be safe and may provide an alternative strategy in the management of bleb failure.
Dr. Prem-Venkatesh, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. premvenkatesh@hotmail.com
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
