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Editors Selection IGR 21-4

Surgical treatment: Transconjunctival suturing for hypotony

Comment by Esther Hoffmann on:

24910 Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy, Letartre L; Basheikh A; Anctil JL et al., Canadian Journal of Ophthalmology, 2009; 44: 567-570

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The retrospective study by Letartre et al. (1712) evaluates the efficacy of transconjunctival suturing of the scleral flap in improving hypotony maculopathy resulting from overfiltration after trabeculectomy. The authors included 35 eyes of 33 glaucoma patients. All patients underwent flap suture using a 10.0 nylon suture with a round spatula needle. One to five (Mean 2.1 ± 0.4) sutures were placed. Interestingly, the duration of hypotony before surgery was 108.0 ± 68.3 days which seems quite long. However, the authors did not find a statistically significant difference in the visual outcome between patients with long versus short duration hypotony maculopathy. The success rate was 94% after six months defined as an intraocular pressure of equal or more than 6 mmHg. Visual acuity increased from 20/100 (median) preoperatively to 20/30 (median). High myopic eyes showed lower postoperative IOP compared to the other eyes. No complications occurred. Despite its retrospective design, the paper is very interesting and important since it again demonstrates that this simple surgical technique to treat hypotony maculopathy after glaucoma surgery is safe and effective and avoids the re-opening of the conjunctiva. It therefore, agrees with previous reports.

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