The use of a "cheese-wire" suture in trabeculectomy.
OBJECTIVE
To report a preliminary study on the safety and efficacy of the use of a cheese-wire suture in trabeculectomy.


METHODS
The case notes of 32 eyes of 25 patients with medically uncontrolled glaucoma who underwent trabeculectomy with cheese-wire suture at Stobhill Hospital, Glasgow, UK, between July 2001 and September 2002 were studied retrospectively. Diagnoses included primary open angle glaucoma (n = 24), normal tension glaucoma (n = 3), angle closure glaucoma (n = 2), ocular hypertension (n = 1), angle recession glaucoma (n = 1) and combined mechanism glaucoma (n = 1). The mean presenting intraocular pressure (IOP) was 29.5 mm Hg and mean intraocular pressure before operation was 23.5 mm Hg


METHODS
Success was defined as lowering of IOP by at least 15% compared with IOP before removal.


RESULTS
A total of 20 eyes (62%) underwent removal of the cheese-wire suture. 17 eyes (85%) underwent removal for therapeutic reasons (failing/failed blebs) and three eyes (15%) underwent suture removal as the suture loops were exposed. The timing of removal was between 2 weeks and 12 months following surgery. A successful outcome was seen in 12/17 (70%) eyes in the eyes that had therapeutic suture removal. 15 eyes had undergone previous surgical interventions (trabeculectomy n = 12, extracapsular cataract extraction n = 1 and laser peripheral iridotomies n = 2). Mean IOP before removal was 23.66 mm Hg and mean IOP immediately following removal was 11.33 mm Hg. Of the 32 eyes that underwent trabeculectomy with cheese-wire suture, 24 eyes had intraoperative mitomycin C and one eye had 5-fluorouracil. The remaining seven eyes did not have any antimetabolites. Early complications related to the surgical procedure included conjunctival haematoma in one eye (3%), corneal abrasion in one eye (3%), wound leak in five eyes (15%), shallow anterior chamber in one eye (3%), hyphaema in six eyes (18%), choroidal effusion in six eyes (18%) and raised IOP in two eyes (6%). Late complications of suture exposure occurred in three eyes (9%). Complications related to removal of the cheese-wire suture included suture breakage in two eyes (10%), hypotony in one eye (5%) and transient hyphaema in one eye (5%).


CONCLUSIONS
The use of cheese-wire suture in trabeculectomy appears to be safe and may provide an alternative strategy in the management of bleb failure.
Prem-Venkatesh
Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. premvenkatesh@hotmail.com
Ramamurthi
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Montgomery
D M I
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin