Trabeculectomy with releasable sutures
A. E. Kolker, M. A. Kass and J. L. Rait
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Mo.
OBJECTIVE: To determine whether the use of releasable scleral-flap sutures
affects the success rate and the incidence of complications following
trabeculectomy. DESIGN: A retrospective chart review of a consecutive
series of trabeculectomies. SETTING: A university-based referral practice.
PATIENTS: Two hundred fifty-eight consecutive patients (274 eyes)
undergoing trabeculectomy because of uncontrolled glaucoma. INTERVENTION:
During the first year, 124 patients (128 eyes) underwent trabeculectomies
with permanent scleral-flap sutures. During the second year, 134 patients
(146 eyes) underwent trabeculectomies with releasable scleral-flap sutures.
MAIN OUTCOME MEASURES: Incidence of flat and shallow anterior chamber,
incidence of operations to drain choroidal detachment and to re-form
anterior chamber, and long-term control of intraocular pressure. RESULTS:
In the group with permanent sutures, 42 eyes (32.8%) had clinically
detectable shallowing of the anterior chamber in the early postoperative
period. In contrast, a shallow anterior chamber was noted in 21 eyes
(14.4%) in the group with releasable sutures (P = .0003). Flat anterior
chamber, defined as iridocorneal apposition to the pupil margin, occurred
in 11 eyes with permanent sutures (8.6%) but in only two eyes (1.4%) with
releasable sutures (P = .0078). Surgical intervention to drain
suprachoroidal fluid and re-form the anterior chamber was required in eight
eyes with permanent sutures (6.2%) but in only one eye with releasable
sutures (0.7%) (P = .014). At 1-year follow-up, the two groups were similar
in terms of intraocular pressure and the need for ocular hypotensive
medications. CONCLUSIONS: Releasable scleral-flap sutures reduce the
incidence of shallow and flat anterior chamber after trabeculectomy without
compromising long-term control of intraocular pressure.
