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AP Wells, C Bunce, PT Khaw; Flap and Suture Manipulation after Trabeculectomy with Adjustable Sutures: Titration of flow and Intraocular Pressure in Guarded Filtration Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3370.
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Purpose:To describe the intraocular pressure (IOP) changes resulting from scleral flap suture manipulation and scleral flap manipulation in conventional guarded filtration surgery Methods:Trabeculectomy sites were fashioned in the sclera with two adjustable sutures in donor human eyes connected to a constant flow infusion and a real-time IOP monitoring. Three different interventions (posterior lip massage, direct suture manipulation, and suture removal) were tested in multiple iterations in varying order on the completed operation sites (n=9) in five eyes. The success of each procedure in lowering IOP to the target range of 7-15 mmHg within 5 repeated interventions, the time to re-establish equilibrium IOP, and the frequency of IOP less than 5 mmHg were recorded for multiple procedures in varied order for each trabeculectomy site. Results:Posterior lip massage, direct suture manipulation, and suture release lowered the IOP after stabilisation to the target range in less than 5 interventions in 9%, 100%, and 14% respectively (P<0.001). For individual interventions, 1.7% of massages, 13.3% of suture releases, and 48% of suture manipulations reached the target range (P<0.001). The median time for IOP to stabilise at the new level after each manipulation, after correction for the flow rates used, was 35.4 minutes for massage, 3.5 minutes for direct suture manipulation, and 8.0 minutes for release (P<0.001). View OriginalDownload SlideView OriginalDownload Slide Conclusion:These results suggest that direct suture manipulation may be superior to both posterior lip massage and suture release for managing IOP in the early phase following glaucoma surgery. Successful manipulations of the scleral flap and associated adjustable sutures to lower IOP in the early postoperative phase after trabeculectomy depend on decreasing suture tension. Following clinical interventions that result in loss of anterior chamber volume, IOP checks should be made at least 40 minutes post - intervention or at a later time afterwards if there is a clinical risk of low aqueous production.
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