Suture manipulation post-trabeculectomy: A practical guide

Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow?ups and management of the blebs play a critical role in the long?term success. This video is aimed at showing the real?world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture?related complications and their management have been shown along with practical examples

Clinic observation of effect and timing of laser suture lysis in reducing intraocular pressure after trabeculectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the changes in intraocular pressure(IOP)after laser suture lysis after trabeculectomy associated with 5-Fluoroaracil and the correlate the effect in relation to the time of laser suture lysis.<p>METHODS: Prospective interventional study of sixty eyes of sixty patients. Trabeculectomy associated with 5-Fluoroaracil was performed for 60 patients with glaucoma. Laser suture lysis was carried out according to the IOP of post trabeculectomy. 21mmHg was used as the cut off for the achievement of target IOP. According to the timing of laser suture lysis, patients post trabeculectomy were divided into three groups: <2wk, 2^nd-4^thwk and >4wk.<p>RESULTS: The differences of IOP prelaser suture lysis showed no statistical significance among three groups(<i>P</i>=0.999). The difference of IOP following 12wk post laser suture lysis showed significant statistical significance(<i>P</i><0.05)among three groups. When laser suture lysis was performed during 2^nd-4^th week post trabeculectomy, 28 patients(74%)achieved the target IOP. Target IOP achieved is negatively correlated to higher week of lysis(<i>P</i>_trend=0.069).<p>CONCLUSION: Laser suture lysis during 2^nd-4^th week post trabeculectomy associated with 5-Fluoroaracil is an effective and safe technique for reducing IOP.

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.

Laser Suture Lysis after Trabeculectomy

We studied the efficacy of laser suture lysis in the promotion of filtration and bleb formation during the early postoperative period after trabeculectomy. Laser suture lysis was performed on thirty-two eyes of thirty patients considered overtight scleral flap suture among patients who underwent trabeculectomy with mitomycin-C, using an argon laser and a Hoskins lens. Patients were entered into the study if, after ocular massage, the intraocular pressure(IOP) was greater than our target pressure(8-12mmHg) 48 Hours after surgery, deep quiet anterior chamber, weak or no bleb formation, no bleb leakage, and a patent internal ostium on gonioscopy. Intraocular pressure measured within 5 minutes of lysis and gentle ocular massage was employed if there was no sopontaneous bleb formation. A further suture was lysed if at this stage there was still no bleb associated with a high IOP. Suture lysis was successful in all cases in the early postoperativy period. The mean IOP before lysis was 22.1mmHg and after serial lysis 9.8mmHg. Complications were noted with laser suture lysis: shallowing of anterior chamber, ocular hypotony, sunconjunctival hemorrhage, hyphema and cataract. All resolved with appropriate management. Laser suture lysis is a safe, effective, and non-invasive method, It can avoid surgical manipulation and increase long term success rate of trabeculectomy.