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January 1994

Trabeculectomy With Releasable Sutures

Author Affiliations

From the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Mo. Dr Rait is currently affiliated with The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia. The authors have no proprietary interest in the techniques described in this article.

Arch Ophthalmol. 1994;112(1):62-66. doi:10.1001/archopht.1994.01090130072020

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.

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