Trabeculectomy with releasable sutures in primary glaucoma: A comparative study with the conventional technique (original) (raw)
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Aim: To assess the safety and efficacy of sutureless punch trabeculectomy, as a substitute for conventional scleral flap trabeculectomy, in the management of primary open angle glaucoma. Materials and methods: In a prospective, randomized study, 40 eyes of 40 patients with primary open angle glaucoma (POAG), who were candidates of trabeculectomy were included and randomly assigned into two groups, conventional scleral flap trabeculectomy (A) or sutureless scleral tunnel trabeculectomy (B). Assessment of intraoperative complications and postoperative visual acuity, intraocular pressure, antiglaucoma medications used and postoperative complications were followed for a period of 6 months. Results: The mean preoperative IOP in the conventional group was 26.7 ± 3.010 mm Hg and in the sutureless group was 26.6 ± 3.067 mm Hg. The mean reduction in IOP in the conventional group after 6 months was 12.4 ± 0.350 mm Hg and in the sutureless group was 12.3 ± 0.407 mm Hg. The complete success rate in Group A was 55% and in Group B was 50%.No significant difference in complication rate was noted between the two groups. Conclusion: It was seen that the sutureless scleral tunnel trabeculectomy has efficacy and safety comparable to conventional scleral flap trabeculectomy and hence can be used as a substitute for conventional scleral flap trabeculectomy.
Sutureless versus Conventional Trabeculectomy for Management of Primary Open Angle Glaucoma
Iranian Journal of Ophthalmology
To assess the efficacy and safety of sutureless punch trabeculectomy as substitute for conventional scleral flap trabeculectomy. Methods: In a prospective, randomized study, 44 eyes of 42 patients with primary open angle glaucoma (POAG) who were candidate of trabeculectomy were included and randomly assigned into two groups; sutureless punch trabeculectomy or conventional scleral flap trabeculectomy. Intraoperative complications and postoperative visual acuity, IOP, bleb status, and complications were evaluated for a follow-up period of 6 months. Results: Mean IOP was 21.9±7.9 mmHg before surgery and 16.0±4.7 mmHg 6 months after surgery in sutureless group, and 22.7±10.2 preoperatively and 15.8±5.2 postoperatively in the control group. No significant difference in complication rate was noted between the two groups. The absolute success rate was 50% and 59% in study and control group, respectively (P=0.545), and qualified success rate was 86.3% and 90.9% in the study and control group, respectively (P=0.365). Conclusion: It appears that sutureless scleral tunnel trabeculectomy is a safe and effective drainage procedure for treating uncomplicated POAG, and can effectively substitute for conventional scleral flap trabeculectomy.
Trabeculectomy: is releasable suture trabeculectomy a cause of better bleb?
Romanian Journal of Ophthalmology, 2021
Purpose: To compare the outcome of fixed suture trabeculectomy with releasable suture trabeculectomy in terms of IOP control, bleb morphology, complications and need of antiglaucoma medication post-surgery. Methods: This study enlisted 200 cases of open angle glaucoma, whose IOP was uncontrolled despite maximal medication. Trabeculectomy was performed using releasable suture in one group of 100 patients and fixed suture in another group of 100 with mitomycin 0.02% in both groups. The study was randomized, the method being the simple randomization. Fornix based trabeculectomy was done in both groups. Two 10-0 nylon releasable sutures were used at two corners of the rectangular flap and one fixed 10-0 vicryl suture was used in the center of the flap. Two mattress sutures (conjunctiva cornea) were also used. Essentially, all the sutures were removed postoperatively over a period of 2-4 weeks depending upon the level of IOP. Mitomycin c 0.02% was used in both groups. Results: The mean p...
International Ophthalmology, 2014
The aim of this study was to compare the outcome and complications of sutureless trabeculectomy with conventional trabeculectomy. A total of 52 eyes were randomly assigned to two groups. One group received standard conventional trabeculectomy and the other group received sutureless trabeculectomy. The patients were evaluated at 1, 3, 6 and 12 months after surgery. Patient data such as sex, age, intraocular pressure (IOP), logMAR visual acuity, antiglaucoma medications, and intraoperative and postoperative complications were collected and statistically analyzed. The mean age of the conventional and sutureless groups was 48.5 ± 15.4 and 57.3 ± 13.9 years, respectively. All patients achieved IOP levels \21 mmHg with a mean IOP of 13.4 ± 5.3 mmHg in the conventional group and 12.8 ± 2.6 mmHg in the sutureless group at 6 months and 11.00 ± 1.3 and 12.4 ± 3.2 mmHg at 12 months post surgery, respectively. These results showed a significant decrease compared to preoperative measures but did not show a significant difference between the two groups (p = 0.659). The number of antigalucoma medications used postoperatively showed a significant decline from preoperative status of 0.7 ± 0.58 in the conventional group and 0.4 ± 0.4 in the sutureless trabeculectomy group after 6 months and 0.68 ± 0.8 and 0.78 ± 0.9 after 12 months, respectively; however, there was no significant difference between the two groups (p = 0.112). No intraoperative complications were encountered in any of the groups. One patient in the sutureless trabeculectomy group developed mild hyphema which was managed medically. In the conventional group, two patients had failed trabeculectomy which was successfully revised, two patients showed hypotony 2 days after surgery which was managed medically and normal pressure was achieved within 5 days. Sutureless trabeculectomy appears to be a safe and easy method with results comparable to conventional trabeculectomy.
Eye, 2022
BACKGROUND/OBJECTIVES: To evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery. SUBJECTS/METHODS: Survey of experienced surgeons who perform trabeculectomy. RESULTS: Forty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/ 47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/ 47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3-4 months (28/47, 59.6%). CONCLUSIONS: Although a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.
Clinical ophthalmology (Auckland, N.Z.), 2015
In this paper, we describe 360° suture trabeculotomy (360°LOT) ab interno and the short-term course in patients who underwent this procedure. We prospectively studied 12 patients (12 eyes) with open-angle glaucoma who underwent 360°LOT ab interno at the Sato Eye Clinic between February and July 2014. The surgical procedure involved making a 1.7 mm temporal corneal incision, exposing an approximately 15° opening in the inner wall of Schlemm's canal (nasal side) using a Trabectome with a gonioscope, and inserting a 5-0 nylon suture rounded at the tip into Schlemm's canal opened via the anterior chamber. The suture was then threaded around Schlemm's canal, and the tip of the suture that emerged on the other side was then advanced through the opening to make a circumferential incision. Intraocular pressure (IOP), number of anti-glaucoma medications used, complications, and the surgery completion rate were prospectively studied. Mean IOP, which was 19.4 mmHg at baseline, show...
Two Suturing Approaches with Punch Trabeculectomy: A Prospective Randomized study
Scientific Research Journal
Two Suturing Approaches with Punch Trabeculectomy: A Prospective Randomized study Aims: To evaluate the outcomes of punch trabeculectomy with two different suturing methods (tight versus loose nonreleasable apical suture with additional releasable sutures as needed). Methods: Eighty Patients with uncontrolled glaucoma and their ages were between 40 and 60 years. Participants were inclusive, randomly distributed for tight non-releasable apical suture technique group (group A-forty patients) and secure/loose suture at the apex of the triangular scleral flap technique group (group B-forty patients). During trabeculectomy, we used two releasable stitches at the sides of the flap in group A and two-four releasable stitches at the sides of the flap in group B. Results: The mean preop-IOP with treatment was 21.17mmHg in group A and 21.02mmHg in group B. In group A, the mean IOP was 17.9 mmHg ± 3.57 (range24-13 mmHg), and 14.82 mmHg ± 1.86 (range19-12mmHg) in group B at one year follow up. (p<.000) All measurements of IOP in both groups were statistically reduced compared with the baseline IOP (P<.000). In survival analysis there was significant difference in time to raise IOP and starting glaucoma medication (P = .005). Flat bleb (40%), encysted bleb (15%), and diffuse bleb (45%) reported in group A versus flat bleb (10%), encysted bleb (2.5%), and diffuse bleb (87.5%) reported in group B. Needling procedure was done for eight cases in group A. Transient hypotony reported in 3 eyes (7.5%) in group B. Conclusion: Comparing two different trabeculectomy suturing methods (tight vs. loose non-releasable apical suture with additional releasable sutures as needed, we found good controlling of IOP, limited number of glaucoma medications and diffuse bleb in 87.5% of cases of secure/loose suture at the apex of the triangular scleral flap. The tight non-releasable apical suture may be the source of 40% flat bleb and 15% encysted bleb in group A.
Ophthalmology and Therapy
Introduction: The aim of this study was to evaluate the efficacy of trabeculectomy with suprachoroidal derivation in eyes with uncontrolled glaucoma after a 24-month follow-up period. Methods: This was a prospective uncontrolled non-randomized case series. All patients scheduled for a trabeculectomy due to uncontrolled glaucoma at the ''Instituto de Glaucoma y Catarata'' (Lima, Peru) between 2011 and 2014 were included. Thee patients underwent trabeculectomy with mitomycin C and suprachoroidal derivation with two autologous scleral flaps. Postsurgical follow-up visits took place on day 1, and at 1, 6, 12, 18 and 24 months. Best corrected visual acuity (BCVA), intraocular pressure (IOP) and complications at each control were registered. Main outcome measures were IOP reduction, number of glaucoma medications and complication rate. Postoperative IOP of [ 21 mmHg, \ 5 mmHg, additional glaucoma surgery or severe complications were considered as indications of failure. Results: Thirty-three participants (41 eyes) were included in the study, of whom 27 (81.82%) (31 eyes [75.61%]) finished the 24 months of follow-up. At the end of the follow-up, mean IOP had decreased by 11.29 ± 9.32 mmHg (p \ 0.001), and glaucoma medication usage in 25 (25/31; 80.65%) eyes had stopped. Ten (10/41; 24.39%) patients complained of blurred vision, and 15 (15/41; 36.59%) patients referred to foreign body sensation the first day after surgery; both sensations resolved spontaneously after 1 week in all cases. No failures, significant changes in BCVA (p = 0.387) or severe complications were found. Conclusions: In this case series, trabeculectomy with suprachoroidal derivation exhibited high efficacy and safety after a 24-month follow-up. A larger sample with a control group is needed to confirm our initial findings.
Trabeculectomy function after cataract extraction
Ophthalmology, 1998
To examine the effect of cataract extraction (CE) after trabeculectomy on intraocular pressure (IOP) control. Design: Retrospective noncomparative case series. Participants: A total of 115 consecutive patients who underwent extracapsular CE (N 5 58) or phacoemulsification (N 5 57) with intraocular lens (IOL) placement after trabeculectomy were studied. Intervention: Cataract extraction with IOL after trabeculectomy was performed. Main Outcome Measures: Preoperative, intraoperative, and postoperative factors were evaluated for association with loss of IOP control requiring additional medications, bleb needling, or further glaucoma surgery, using Kaplan-Meier survival analysis and Cox multivariate proportional hazards survival regression. Results: After mean postoperative follow-up of 21.1 6 14.3 months, additional glaucoma medication or needling of the filtering bleb to maintain IOP control was required in 35 eyes (30.4%) and was significantly associated with intraoperative iris manipulation and early postoperative peak IOP greater than 25 mmHg. Additional glaucoma surgery was eventually required in 11 eyes (9.6%) and was significantly associated with age of 50 years or younger, preoperative IOP greater than 10 mmHg, and early postoperative peak IOP greater than 25 mmHg. The cumulative proportion of patients who did not require reoperation for glaucoma was 93% and 90% at 1 and 2 years, respectively. The mean IOP at last visit had increased 1.6 mmHg above the pre-CE level and did not vary significantly after the first postoperative month. The median interval from CE to the addition of glaucoma medication or bleb needling was 1.6 months (within 3 months in 20 of 33 eyes) and that from nonsurgical intervention to further glaucoma surgery was 3.6 months (before the 7th postoperative month in 6 of 11 eyes). Of 19 eyes with hypotony (IOP ∂ 6 mmHg) before CE, 11 eyes remained hypotonous after CE despite an increase in the mean IOP from 4.6 to 7.5 mmHg. Conclusions: When CE is performed after trabeculectomy, age of 50 years or younger, preoperative IOP greater than 10 mmHg, intraoperative iris manipulation, and early postoperative IOP greater than 25 mmHg are associated with worsened postoperative IOP control. Most bleb failures occur soon after CE. Resolution of pre-existing hypotony after CE is unpredictable.