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Editors Selection IGR 18-3

Laser and surgical treatment: Transconjunctival sutures for hypotony

Comment by Shan Lin on:

20889 Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs, Nagai-Kusuhara A; Nakamura M; Fujioka M et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2008; 246: 567-571

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Eha et al. (874) conducted a prospective interventional case series on the use of transconjunctival sutures for treating hypotony maculopathy after trabeculectomy with mitomycin C. Sixteen eyes with intraocular pres-sures (IOP)of 6 mmHg or lower and coexisting hypotony maculopathy were treated with transconjunctival 10-0 nylon sutures to close the scleral flap. These cases were done under topical anesthesia. Average vision improved from 20/160 to 20/63 and mean IOP went from 2.8 mmHg to 9.6 mmHg, at six months follow up. No signifi cant complications occurred. Sutures became absorbed into the bleb in three to ten days after surgery. Laser suture lysis was needed in 6 eyes to lower IOP in the post-operative period. Although a previous report has described the use of transconjunctival sutures for closing the flap (Shirato et al. Am J Ophthalmol 2004; 137: 173-174), the present study has a larger number of patients and relatively long follow up. In addition, pre-operative optical coherence tomography (OCT) of the macula was performed to objectively document macular folds. Other approaches to the surgical correction of overfiltering blebs have been described and found to be effective (Schwartz et al. J Glaucoma 1996; 5: 246-251). However, the present study provides expanded data on a practical, less invasive corrective procedure for the treatment of hypotony maculopathy associated with overfiltration. One minor criticism may be that OCT data was not presented of the macular appearance after the corrective procedure, to help document structural improvement of the macular folds.

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