Healio
Healio

Wills Eye Conference
Issue: April 10, 2012
February 28, 2012
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Full-thickness suturing technique may resolve hypotony in patients with filtering blebs

Issue: April 10, 2012
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Jesse Richman, MD
Jesse Richman

PHILADELPHIA — Full-thickness conjunctival and scleral sutures proved effective in titrating bleb flow and regulating IOP, according to a study presented here.

"These full-thickness sutures are an effective way to treat hypotony. They preserve the bleb, and by selecting which sutures to remove postoperatively, we get a very nice outcome," Jesse Richman, MD, said at the Wills Eye Institute Alumni Conference.

The retrospective study included 10 patients with an average age of 67.4 years who had previously undergone trabeculectomy alone or in combination with cataract extraction.

The technique involved placing full-thickness sutures through the conjunctiva and sclera and tying them tightly in the former trabeculectomy site. Patients received an average of 8.8 sutures. Six patients underwent selective suture removal 1 day to 12 weeks postoperatively.

One patient experienced leakage at the site of the suture removal; the leak self-sealed within 1 week. One patient had persistent elevated IOP requiring implantation of a shunt.

Patients were examined 1 day, 1 week, 1 month, 3 months and 5 months postoperatively.

Average preoperative IOP was 3.8 mm Hg. Results showed that mean IOP was 24 mm Hg 1 day after surgery, 14.8 mm Hg at 1 week, 16 mm Hg at 4 weeks and 12 mm Hg at 3 months and 5 months. Hypotony was successfully resolved in all patients.

Clinicians have launched a prospective study to further analyze outcomes of the procedure, Dr. Richman said.

  • Disclosure: Dr. Richman has no relevant financial disclosures.

Perspective

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Jonathan S. Myers, MD, and Marlene Moster, MD

Dr. Richman and co-workers have presented a modified transconjunctival suturing technique for overfiltration following trabeculectomy. A transconjunctival suturing technique was reported by Shirato in 2004 but its widespread adoption has been slow. The modified technique developed by Dr. Moster utilizes the transconjunctival approach, but also has aspects similar to Paul Palmberg’s external compression sutures.

It is counterintuitive to many that transconjunctival suturing techniques do not routinely result in leaks and other complications. It appears that the sutures compress the tissue in the immediate area, preventing leaks. Once the conceptual barrier is crossed, many surgeons have found transconjunctival techniques easy to adopt, and much less involved than a full bleb revision. Sometimes traditional thinking, based on consensus more than science, can stand in the way of innovative ideas. This technique is one example of conceptual breaks with established thinking that studies suggest may be helpful options.

References:

  • Palmberg P, Zacchei A. Compression sutures — a new treatment for leaking or painful filtering blebs. Invest Ophthalmol Vis Sci. 1996;37:S444.
  • Shirato S. Maruyama K, Haneda M. Resuturing the scleral flap through conjunctiva for treatment of excess filtration. Am J Ophthalmol. 2004;137(1):173-174.
Jonathan S. Myers, MD, and Marlene Moster, MD
Glaucoma Service, Wills Eye Institute
Disclosures: Drs. Myers and Moster have no relevant financial disclosures.
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