Trabeculectomy with releasable sutures.
OBJECTIVE
To determine whether the use of releasable scleral-flap sutures affects the success rate and the incidence of complications following trabeculectomy.


METHODS
A retrospective chart review of a consecutive series of trabeculectomies.


METHODS
A university-based referral practice.


METHODS
Two hundred fifty-eight consecutive patients (274 eyes) undergoing trabeculectomy because of uncontrolled glaucoma.


METHODS
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.


METHODS
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.
Kolker
A E
AE
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Mo.
Kass
M A
MA
Rait
J L
JL
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery; D013524:Surgical Flaps; D013536:Suture Techniques; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome