title: Flap suture--a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C.
abstract: BACKGROUND
  A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy, papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC.
  
  
  METHODS
  In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included. Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera. Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging of the posterior pole were performed.
  
  
  RESULTS
  Before surgery (flap suture), the mean IOP was 2.8 mmHg (+/-1.1; range from 1 to 4 mmHg). It was 24.9 +/- 11.7 mmHg (range; 9-48 mmHg) on the 1st postoperative day, 15.7 +/-8.1 mmHg (range; 5-35 mmHg) on day 7, 11.1 +/-4.1 mmHg (range; 5-20 mmHg) 1 month after surgery, 9.3 +/-3.9 mmHg (range; 2-20 mmHg) after 3 months, and 9.6 +/-4.2 mmHg (range; 2-20 mmHg) after 6 months. The best corrected mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively. Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up.
  
  
  CONCLUSIONS
  Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided.
authors.affiliation: Department of Ophthalmology, Johannes Gutenberg-University, Langenbeckstr. 1, 55101 Mainz, Germany. Eha@augen.klinik.uni-mainz.de
authors.forename: Judith
authors.initials: J
authors.lastname: Eha
authors.forename: Esther M
authors.initials: EM
authors.lastname: Hoffmann
authors.forename: Jochen
authors.initials: J
authors.lastname: Wahl
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005902:Glaucoma, Open-Angle / Q000151:congenital / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D015814:Ocular Hypotension / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D013524:Surgical Flaps; D013536:Suture Techniques; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D014792:Visual Acuity
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin