Laser Suture Lysis after Trabeculectomy

ABSTRACT

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.