Corneal traction suture variation may prevent trab complications

Issue: November 1, 2002

ByMichael J. Smith, MD, MS

ByPeter R. Simcock, FRCOphth

Use of a superior rectus traction suture during trabeculectomy can result in hemorrhage into the subconjunctival space. This can increase subsequent scarring, which may compromise bleb function. The superior rectus suture can also distort the conjunctiva, making accurate closure of the conjunctival incision difficult.

Corneal traction sutures prevent such complications from occurring. We describe a variation of the corneal traction suture for trabeculectomy that provides good downward rotation of the globe without traumatizing or distorting the superior conjunctiva or cornea.

In 1973 Cohen suggested two corneal sutures at the 4 and 8 o’clock positions, and in 1991 Conklin et al described a single suture through the superior cornea at the 12 o’clock position.

Some techniques for the placement of releasable sutures require passage of the suture near the 12 o’clock position. We use a technique that keeps the superior cornea and conjunctiva free of any traction suture.

A single-ended 8/0 Vicryl suture is placed through the cornea at 50% thickness from inferior to superior temporally then nasally at the 3 and 9 o’clock positions. When the second corneal pass is completed, the needle is hooked under the loop of suture between the temporal and nasal insertions and pulled upward with the dominant hand. The nondominant hand holds the free end of the suture with forceps. The suture is adjusted until all four lengths are equal, then an assistant places a clip across them. The sutures are then passed around the inferior aspect of a wire lid speculum.

A single-ended 8/0 Vicryl suture is placed through the cornea at 50% thickness from inferior to superior temporally.	A suture is then placed at the 3 and 9 o’clock positions.
The suture is adjusted until all four lengths are equal, then an assistant places a clip across them.	The sutures are then passed around the inferior aspect of a wire lid speculum.

For Your Information:

Michael Smith, FRCOphth, and Peter R. Simcock, FRCOphth, can be reached at West of England Eye Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, England; (44) 1392-411-611; fax: (44) 1392-406-022; e-mail: psimcock@hotmail.com.

References:

Cohen SW. Downward rotation of the globe using corneal traction sutures. Letter, Am J Ophthalmol. 1973;76:159-160.