Abstract
Introduction The aim of this prospective study is to verify, in terms of both early postoperative complications and intraocular pressure (IOP) outcomes, the performance of a scleral flap removable suture. Materials and Methods Sixty-six patients that underwent trabeculectomy were randomly divided into two groups: in the first group (group A, 33 eyes) a standard fornix-based trabeculectomy was performed by using a conjunctival chain suture. In the second group (group B, 33 eyes) the same technique was performed with the additional employment of a new removable suture to the scleral flap. The patients were followed-up for 12 months. Results After 1 year the mean IOP was 16.58 mmHg (±3.73 mmHg) in group A, and 16.12 mmHg (±4.21 mmHg) in group B; statistical analysis did not show significant differences between the two groups (P = 0.19). Early postoperative hypotony and shallowing of the anterior chamber were significantly more frequent after standard trabeculectomy than after trabeculectomy using the removable suture (P < 0.02). Conclusions The employment of a fornix-based conjunctival chain suture for the flap allows the use of the removable scleral flap suture, which has proved very effective in preventing insufficient flap resistance with aqueous overdrainage and hypotony, and which is also easy to apply and to remove. Compared with standard trabeculectomy, this device has proved to have similar IOP-lowering efficacy, together with a lower rate of early postoperative complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Shirakashi M, Iwata K, Sawaguchi AS et al (1993) Intraocular pressure-dependent progression of visual field loss in advanced primary open angle glaucoma: a 15-years follow-up. Ophthalmologica 207:1–5
Chauhan BC, Drance SM (1992) The relationship between intraocular pressure and visual field progression in glaucoma. Graefes Arch Clin Exp Ophthalmol 230:521–526
Jay JL, Murray SB (1988) Early trabeculectomy versus conventional management in primary open-angle glaucoma. Br J Ophthalmol 72:881–889
Migdal C, Gregory W, Hitchings RA (1994) Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology 101:1651–1657
Sanchez E, Schnyder CC, Sickenberg M, Chiou AG, Hediguer SE, Mermoud A (1996–1997) Deep sclerectomy: results with and without collagen implant. Int Ophthalmol 20:157–162
Stegmann R, Pienaar A, Miller D (1999) Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 25:316–322
Wilson MR, Mendis U, Paliwal A, Haynatzka V (2003) Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy. Am J Ophthalmol 136:464–470
Wamsley S, Moster MR, Rai S, Alvim HS, Fontanarosa J (2004) Results of the use of the Ex-PRESS miniature glaucoma implant in technicallychallenging, advanced glaucoma cases: a clinical pilot study. Am J Ophthalmol 138(6):1049–1051
Cairns JE (1972) Trabeculectomy: symposium: microsurgery of the out-flow channels. Trans Am Acad Ophthalmol Otolaryngol 76:384–388
Watson P (1970) Trabeculectomy—a modified ab externo tecnique. Ann Ohpthalmol 2:199
Zohdy GA, Lukaris A, Rogers ZA, Hill A, Roberts-Harry TJ (1998–1999) Early results of punch trabeculectomy. Int Ophthalmol 22(4):253–256
Khaw PT (2001) Advances in glaucoma surgery: evolution of antimetabolite adjunctive therapy. J Glaucoma 10(5 Suppl 1):S81–4 Review
Jones E, Clarke J, Khaw PT (2005) Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 16:107–113
Caporossi A, Casprini F, Tosi GM, Balestrazzi An (1999) Long term results of combined 1-way phacoemulsification, intraocular lens implantation and trabeculectomy. J Cataract Refract Surg 25(12):1641–1645
Stalmans I, Gillis A, Lafaut A-S, Zeyen T (2006) Safe trabeculectomy technique: long term outcome. Br J Ophthalmol 90:44–47
Bannit M, Juzych MS, Chopra V et al (2006) The effect of the timing of scleral flap suture release on the safety and long-term success of phacotrabeculectomy. Am J Ophthalmol 141(4):742–744
Ashraff NN, Wells AP (2005) Transconjunctival suture adjiustment for initial intraocular pressure control after trabeculectomy. J Glaucoma 14(6):435–440
Wells AP, Bunce C, Khaw PT (2004) Flap and suture manipulation after trabeculectomy with adjustable suture: titration of flow and intraocular pressure in guarded filtration surgery. J Glaucoma 13(5):400–406
Simsek T, Cititrik M, Batman A, Mutevelli S et al (2006) Efficacy and complications of releasable suture trabeculectomy and standard trabeculectomy. Int Ophthalmol 15 (Epub ahead of print)
Yalvac IS, Sahin M, Eksioglu U et al (2004) Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma. Three-year prospective randomised clinical trial. J Cataract Refract Surg 30:2050–2057
Tan JHC, Hitchings RA (2001) Non-penetrating glaucoma surgery: the state of play. Br J Ophthalmol 85:234–237
Spaeth Gl, Mutlukan E (2001) The use of antimetabolites with trabeculectomy: a critical appraisal. J Glaucoma 10(3):145–151
Broadway D, Grierson I, Hitchings R (1993) Adverse effects of topical antiglaucomatous medications on the conjunctiva. Br J Ophthalmol 77:590–596
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Caporossi, A., Balestrazzi, A., Malandrini, A. et al. A randomized prospective study comparing trabeculectomy with and without the use of a new removable suture. Int Ophthalmol 29, 359–365 (2009). https://doi.org/10.1007/s10792-008-9245-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-008-9245-z