Effectiveness of combination of permanent and releasable scleral flap sutures in trabeculectomy: a randomized clinical trial

Abstract

Introduction: Trabeculectomy is a commonly used surgical treatment for glaucoma.

Purpose: To evaluate the effectiveness of combination of permanent and releasable scleral flap sutures to minimize the immediate postoperative complications of trabeculectomy.

Materials and methods: This study was carried out in Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan, Nepal. Forty one eyes of 34 patients undergoing trabeculectomy were randomized to undergo either conventional trabeculectomy (Group A= 20 eyes) or trabeculectomy with combination of permanent and releasable scleral flap sutures (Group B =21 eyes). The parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD) and surgical complications over a period of 6 weeks.

Results: Significantly higher number of eyes belonging to group A (14 eyes) had shallower anterior chamber than group B (7 eyes) on first post operative day (p=0.042). Six eyes (30%) in group A had peripheral or central irido-corneal touch in early postoperative period as compared to only one in Group B. Hypotony was noted in 3 eyes in each group. Two patients in group A required reformation of anterior chamber. Other surgical complications in the two groups were similar. Both the groups had a significant drop in IOP following surgery. However, there was no significant difference in the IOP between the two groups after 6 weeks (Group A: 10.95 +/- 3.03 mmHg vs. Group B: 12.29 +/- 4.67 mmHg; p=0.87). There was a significant drop in IOP following removal of sutures (15.19 +/- 6.15 mmHg to 13.19 +/- 6.13 mmHg; p=006) in group B.

Conclusion: Use of combination of permanent and releasable scleral flap sutures is a safe technique that significantly reduces the incidence of immediate postoperative shallow anterior chamber after trabeculectomy.