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Thandeka Myeni, Jesse Richman, Valerie Trubnik, Marlene Moster; Full Thickness Conjunctival And Scleral Suture Technique For Hypotony After Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2510.
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To describe a surgical technique to resolve hypotony and titrate bleb flow in patients with prior trabeculectomies with mitomycin-C.
The charts of all patients with ocular hypotony repaired by full thickness conjunctival / scleral sutures between January 2009 and October 2011 at Wills Eye Institute were retrospectively reviewed. The surgical technique involved placing several radial interrupted 8-0, 9-0, or 10-0 nylon sutures through the conjunctiva and full-thickness sclera in the area of the prior trabeculectomy. All patients had prior trabeculectomy or combined trabeculectomy with cataract extraction. Patients were not excluded if they had prior alternative treatments for hypotony as long as the other treatments did not resolve the hypotony.Patients were assessed 1 day, 1 week, 4-6 weeks, 3 months, and 5 months following surgery. Sutures were selectively removed in the post-operative period to titrate the intraocular pressure while also maintaining resolution of the hypotony. The outcome measures were the percent with hypotony resolution and post-surgical intraocular pressures.
Ten patients underwent full thickness conjunctival / scleral sutures as treatment of their hypotony. The average age of patients was 67.4 years. The average number of sutures placed during surgery was 8.8. All ten patients had resolution of their hypotony. Sutures were removed in 6 of the patients, with removal ranging from 1 day to 12 weeks after surgery. The average pre-operative intraocular pressure was 3.8 mm Hg (range 2-6 mmHg), which rose to 24 mm Hg (range 8-50 mmHg) one day after surgery. One week after surgery the intraocular pressure was 14.8 mm Hg (range 9-25 mmHg), 16 mm Hg after 4 weeks (range 11-28 mmHg) , 12 mm Hg after 3 months (range 8-15 mmHg), and 12.7 mm Hg after 5 months (range 10-15mmHg). One patient had a leak at the site of suture removal, which sealed 1 week later. One patient required an Express shunt for persistent elevated intraocular pressure.
Full thickness conjunctival / scleral sutures can be an effective way to treat ocular hypotony. Selective suture removal can help achieve a well controlled intraocular pressure.
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