Application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve(AGV)implantation.METHODS: A total of 78 patients(78 eyes)with refractory glaucoma who underwent AGV implantation in the People's Hospital of Leshan from May 2020 to January 2022 were retrospectively analyzed. According to the treatment, the patients were divided into the modified AGV implantation group, with 43 patients(43 eyes)treated by modified AGV implantation, ligating the drainage tube with single-pass four-throw releasable suture, and the traditional AGV implantation group, with 35 patients(35 eyes)treated by traditional AGV implantation. Followed-up for 6mo, the intraocular pressure(IOP), success rate and complications were observed at 1d, 1 and 2wk and 1 and 6mo after operation.RESULTS: Postoperative IOP at all follow-up visits was significantly lower than that before surgery in both groups(all P<0.05). There was no significant difference in IOP between groups at all follow-up visits(all P>0.05). The incidence of shallow anterior chamber was 5% in the modified AGV implantation group and 23% in the traditional AGV implantation group at 1wk after surgery(P<0.05). At 6mo after operation, the overall success rate was 98% in modified AGV implantation group and 89% in the traditional AGV implantation group(P>0.05).CONCLUSION:During AGV implantation, ligation of drainage tube with single-pass four-throw releasable suture can effectively reduce IOP and reduce the incidence of shallow anterior chamber in early postoperative stage. Furthermore, the technique is safe and efficacious.

Suprachoroidal hemorrhage after removal of releasable suture with globe massage post-trabeculectomy

A 19-year-old female, having aniridia with secondary glaucoma, presented with uncontrolled intraocular pressure (IOP) in the right eye (RE) on maximal topical and systemic medications. On examination, RE had a subluxated cataractous lens with advanced cupping. She underwent trabeculectomy with mitomycin C. On postoperative day 1, as the IOP was 32 mmHg, one releasable suture was removed followed by gentle bleb massage. On postoperative day 2, suprachoroidal hemorrhage was noted, for which the patient underwent two drainage procedures. Hemorrhagic choroidals resolved completely 4 weeks after drainage.

An unusual presentation of Pseudomonas aeruginosa blebitis following combined surgery.

We report a case of blebitis that occurred 3 years later following a combined glaucoma and cataract surgery. It was an atypical presentation, as patient had no classical fiery looking signs of blebitis despite the isolated organism being Pseudomonas aeruginosa. Improvized surgical techniques like use of Mitomycin C, releasable flap sutures though considered as part of the recommended procedure for better surgical outcomes, their role as potential risk factors for visually blinding complications like endophthalmitis are often overlooked. This case report throws light on such risk factors for bleb associated infections and recommends removal or trimming of all releasable sutures and the need for a regular postoperative follow‑up.

Intraocular Pressure Change after Glaucoma Implant Surgery with Releasable suture

PURPOSE: To find the factor that affects the long-term intraocular pressure after glaucoma implant surgery with releasable suture. METHODS: We retrospectively reviewed the medical records of the 33 patients (36 eyes) who had undergone glaucoma implant surgery with our own expanded-Polytetrafluoroethylene (e-PTFE) membrane-tube implant with temporary closure of the tube by releasable suture. Data such as timing of suture release, IOP's before and after surgery and the amount of pressure change during follow-up were collected, and we tried to find the factor that influenced the IOP at the last visit. RESULTS: The preoperative IOP was 43.2+/-14.6 mmHg and the suture was released at day 17.9+/-9.5 after surgery. The IOP just before the release of suture was 33.5+/-17.1 mmHg. The pressure was dropped to 15.1+/-13.7 mmHg, measured at 30 minutes after the release of the suture. The IOP was stabilized to 14.9 +/-9.5 mmHg at 12.2+/-7.0 days after the release. The average follow-up was 32.8+/-26.3 months and the IOP at the last visit was 17.3+/-10.5 mmHg. Four eyes (11%) had hypotony (IOP less than 8 mmHg) before release of the suture, thirteen eyes (41%) showed hypotony 30minutes after release, and three eyes(8%) showed hypotony at the last visit. Multiple linear regression analysis revealed that the IOP at 30 minutes after release of the suture had a positive correlation with the IOP at the last visit (r=0.642,p=0.000). CONCLUSIONS: In the membrane-tube implant surgery for the refractory glaucoma, the releasable suture echnique is helpful to prevent the early postoperative hypotony. By measuring early post-release IOP after implant surgery with releasable suture technique, we might predict the behavior of long term IOP change; the lower post-release IOP, the better long-term pressure control.

The Efficacy and Safety of Mitomycin C and Releasable Suture in Glaucoma Triple Procedure

PURPOSE: To evaluate the clinical efficacy and safety of short-term application of mitomycin C and releasable scleral flap sutures. METHODS: The clinical outcome and complications were evaluated in 62 eyes undergone glaucoma triple procedure(Group A: with mitomycin C and releasable suture, Group B: with mitomycin C only, Group C: with releasable suture only, Group D: without mitomycin C and releasable suture). RESULTS: The mean postoperative intraocular pressure was relatively lower in group A and B than that of group C and D(p=0.868). The most common complication was posterior capsular opacity, and other complications were cystoid macular edema, hypotony, choroidal detachment and bleb leakage. CONCLUSIONS: The glaucoma triple procedure using mitomycin C and releasable suture could be recommended to be safe and effective on controlling the early postoperative and long-term intraocular pressure for treating the patients with coexisting cataract and glaucoma, and the use of releasable suture could lower the incidence of postoperative complications such as hypotony.

Releasable suture in phacotrabeculectomy

An externalized releasable suture in phacotrabeculectomy, does not use scleral flap for trabeculectomy but excised posterior lip of sclera ltunnel incision is use to create a fisutula. This provides early visual rehabilitation, good control of postoperative intraocular pressure, maintenance of chamber depth during early postoperative period and reduction of the extent of tissue dissection which may decrease the stimuleus to wound healing and early filteration failure with few complication. We reviewed the effectiveness of an externalized releasable suture in phacotrabeculectomy using 6mm scleral tunnel incision after 6 months of follow-up in 10 eyes of 8 patients with coexisting cataract and glaucoma. At 6 months after operation, the mean intraocular pressure reduction was 13.2 mmHg postoperatively and the number of glaucoma medication decreased from 2.4 to 0.3. NO medication was needed in 8 eyes postoperatively. The visual acuity improved in all eyes and 7 eyes recoveed to 20/40 or better. The several complications such as partial posterior capsule rupture, transient wound leakage, posterior capsule opacity were noted. NO case of shallow anterior chamber was found. $ eyes had slightly increased IOP in the early postoperative period, and subsequent suture removal reduced IOP. In all cases, depth of anterior chamber was well formed. The releasable suture in combined procedure provides a low incidence of postoperative complication due to overfilteration, and makes it possible to increase the degree of filteration by removal when needed during the early postoperative period. this reduces the incidence of shallow and flat anterior chamber without compromising long-term control of intraocular prssure.

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.

Releasable Suture after Tight Scleral-Flap Trabeculectomy with Mitomycin C

Mitomycin C may change the time course for effective releasable scleral-flap suture removal. The authors evaluated the safety and efficacy of releasable scleral-flap sutures in 83 eyes of 61 patients undergoing mitomycin C(MMC) filtering operation. Of these eyes, 38 underwent scleral-flap suture removal and these eyes were divided into three groups according to the timing of suture removal(Group 1: within 3 days after trabeculectomy, Group 2: from 4 to 14 days, Group 3: from 15 to 30 days). The pre-release IOP was 26.0 +/- 7.6, 23.8 +/- 8.5 and 18.4 +/- 4.6 mmHg, respectively. Immediately after releasable suture removal, the percent IOP reduction was 46 +/- 18, 46 +/- 17 and 30 +/- 20%, respectively. The percent IOP reduction after releasable suture removal was greater in the group 1 and group 2 compared with group 3(p<0.05). Mean follow-up period was 9.0 +/- 5.3, 14.4 +/- 7.2 and 12.6 +/- 7.6 months, respectively. Twelve eyes(80%), 12 eyes(100%), 10 eyes(91%) achieved successful control of final IOP of 21 mmHg or less with or without topical antiglaucoma medications, respectively. After releasable suture removal, the shallow anterior chamber was noted in 1 eye, 2 eyes and 1 eye, respectively. One eye developed a hypotony in the group 3. Adjunctive MMC therapy extended the period that releasable scleral-flap suture removal is effective beyond first 2 postoperative weeks. Also these results indicate that this method is efficient for IOP reduction and relatively safe.