Results of Trabeculectomy Using Modified Scleral Flap Suture Technique in Comparison with Standard Trabeculectomy

PURPOSE: To evaluate the efficacy of trabeculectomy using modified scleral flap suture technique METHODS: We retrospectively reviewed the medical records of 52 patients (55 eyes) who had undergone trabeculectomy from January 2003 to January 2007. Standard trabeculectomy was performed for 29 eyes of 27 patients, modified trabeculectomy for 26 eyes of 25 patients. We changed suture site of scleral flap corner about 1mm medially from original site and added tight suture to both lateral margins of scleral flap to prevent overflow in modified group. In both groups, most of patients were injected 0.1 ml of 0.02 mg/ml mitomycin-C (MMC) subconjunctivally and the others 0.1 ml of 0.04 mg/ml MMC. We evaluated intraocular pressure (IOP), complication, morphology of filtering bleb, cumulative success rates. RESULTS: Argon laser suturelysis was performed postoperatively in about half cases of both groups. The IOPs of modified group were consistently lower than those of standard group for 24 months except postoperative 1 day and 1 week. There was a significant difference of IOP at postoperative 2 months and 12 months (p<0.05). No significant difference of complications was found between two groups. The diffuse bleb with microcyst was found in 19 eyes (73%) of modified group and 17 eyes (59%) of standard group. From Kaplan-Meier survival analysis, cumulative success rates of modified group were higher than those of standard group (p<0.05). CONCLUSIONS: Trabeculectomy using modified scleral flap suture appears to give better IOP control than standard trabeculectomy.

The Effect of Modified Trabeculectomy with Partial Excision of Scleral Flap

To investigate the effect of trabeculectomy with the modification of scleral flap, modified trabeculectomy with partially excised scleral flap(PESF) was performed in one eye and trabeculectomy with non-excised scleral flap(NESF) in the contralateral eyes of five rabbits. Postoperative histologic examinations were done on these eyes at 2 weeks after surgery. And 10 PESF and 12 NESF trabeculectomies was performed in 22 glaucoma patients for the control of intraocular pressure(IOP). Results of histologic examination showed less subconjunctival inflammation and fibrosis in PESF group than NESF group. IOP was controlled successfully in PESF(80%) and NESF(75%) group. Mean IOP was 14.7 +/- 4.1 mmHg in PESF group and 16.4 +/- 2.5 mmHg in NESF group at the 2 month follow-up visit. Duration of anterior chamber reformation was 10.7 days in PESF group and 8.9 days in NESF group. And cases of removal of releasable suture were 5 eyes in NESF group but none in PESF grup. This PESF trabeculectomy seems to be a safe and effective procedure that produces diffuse, persistent blebs and good control of IOP.