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L. Quaranta, I. Riva, A. Russo, F. Noto, S. Miglior; Outcome of Conjunctival Compression Sutures for Hypotony After Glaucoma Filtering Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):614.
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© ARVO (1962-2015); The Authors (2016-present)
In the present retrospective study we report the outcomes of conjunctival compression sutures (CCS) for enlarged overfiltering blebs associated with ocular hypotony after uncomplicated trabeculectomy with Mitomycin C (TM).
After conjunctival anesthesia was obtained, a 8-0 nylon suture was placed just anterior to the limbus at a corneal stroma depth of 50%; the suture then courses posteriorly to compress the underlying conjunctiva on either side of the central portion of the filtration bleb, and is anchored using a deep bite in the conjunctiva and Tenon’s capsule. The suture ends were tied to obtain the required degree of conjunctival compression. A second suture was then placed on the other side of the conjunctival bleb, at distance of about 6 mm from the other CCS. Success was defined as an IOP >= 6 mm Hg and < 21 mm Hg with or without glaucoma medications. The date of failure was considered the first visit in which hypotony was recorded.
From January 1998 to January 2006, 45 consecutive patients met the inclusion criteria defined by the study protocol. The mean follow-up was 38 ± 12.5 months. The CCS were removed on average after 12 weeks (range 6 to 20). At the end of the follow-up success was obtained in 29 eyes of 45 patients (64.4%), in providing resolution of the pre-existing hypotony. Of these 29 eyes, 8 eyes had a conjunctival bleb diffusion over 180 degrees (27.6%), 18 eyes (62.06%) overfiltering bleb over 270 degrees, and 3 eyes (10.34%) over 360 degrees. In 22 cases an improvement of visual acuity was seen. In 7 eyes of this group, in spite of an increase of IOP (ranging from 10 to 16 mm Hg), visual acuity did not improve. This was mainly due to the persistency of macular folds. In 8 cases CCS were not effective in reducing aqueous over-filtration, and restoring normal levels of IOP (> 6 mm Hg), after 4 - 6 weeks following sutures placement. In this group of patients 7 had these patients had a conjunctival bleb diffusion over 360 degrees. During the follow-up recurrence of hypotony was observed in 8 eyes. All the recurrences of hypotony were observed in the first 12-month after CCS placement. In all these cases, recurrence of hypotony was associated with re-appearance of overfiltering conjunctival bleb over 270 (2 eyes) and 360 degrees (6 eyes). Complications from CCS included: 5 patients had a transient spike of IOP (ranging from 23 to 26) in the first post-operative week. No major complications were noted.
CCS seems to be a viable and safe surgical technique to manage hypotony due to overfiltering bleb after TM.
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