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Yesenia Yolanda Dorantes Diez, Jose A Paczka, Montserrat Romo Sainz, Luz America Giorgi Sandoval, Karla J Aguilera Ruiz; Transconjunctival Suturing of the Scleral Flap to Treat Persistent Hypotony after Antimetabolite Supplemented Trabeculectomy. One-Year Results on Efficacy and Safety. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4941. doi: https://doi.org/.
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The intraocular pressure (IOP) reduction capacity of the trabeculectomy can sometimes be excessive and predispose to complications. The transconjunctival suture of scleral flap (TCSSF) is a straightforward surgical option to be used when other more conservative methods have failed. This study assessed efficacy and safety of transconjunctival scleral flap suturing in a cohort of Latino patients with persistent hypotony after trabeculectomy.
A series of consecutive cases which underwent mitomycin C (MMC) supplemented trabeculectomy were retrospectively assessed. Cases with complete clinical information with at least one year of follow-up, and in which TCSSF was performed to treat hypotony (IOP ≤5mmHg) persisting for at least 2 months were selected for analysis. Best-corrected visual acuity (LogMAR) and IOP values at baseline as well as those of the follow-up were collected until the final examination; in addition, relevant perioperative information, number of sutures applied, success rate and frequency of complications were recorded.
From 417 eyes (366 patients, 225 female) which underwent MMC- supplemented trabeculectomy in a glaucoma referral center during a 5-year period, 11 (2.6%) of them were identified with persistent ocular hypotony (mean duration 3.9±1.4 months) requiring TCSSF. A mean pre-suture IOP 3.4±1.3 mmHg (range 0-5 mmHg) was statistically different (P=0.001) as compared to all mean post-TCSSF values: 9.5±2.4 mmHg (day 1), 11.2±2.5 mmHg (week 1), 10.3±3.0 mmHg (month 1), 15.6±3.8 mmHg (month 3), 13.7± 3.4mmHg (month 6) and 12.8±3.1 mmHg (month 12). Three cases (27%) persisted with hypotony; two of them underwent additional TCSSF with resolution of hypotony in one of them. The remaining non-responder cases required partial resection of the filtering bulb and direct repair of the scleral flap to get hypotony completely solved. Range of sutures used on the scleral flap was 1-4 (median=2). Best-corrected visual acuity significantly improved after TCSSF (0.5±0.3 to 0.2±0.12, P <0.01). No relevant complications related to the procedure were recorded.
Persistent ocular hypotony due to post-trabeculectomy over-filtration is a well-recognized complication. The transconjunctival suture technique seems to be an effective and safe option to approach persistent hypotony.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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