A standardized protocol of laser suture lysis in postoperative management in trabeculectomy with mitomycin C: One-year study

• Published in: European journal of ophthalmology Vol. 31; no. 2; p. 477
• Main Authors: Mano, Sofia Sousa, Esteves, Raquel Marques, Ferreira, Nuno Pinto, Abegão Pinto, Luís
• Format: Journal Article
• Language: English
• Published: United States 01.03.2021
• Subjects: Aged; Aged, 80 and over; Alkylating Agents - administration & dosage; Clinical Protocols - standards; Device Removal; Female; Glaucoma, Open-Angle - physiopathology; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure - physiology; Laser Therapy - methods; Male; Middle Aged; Mitomycin - administration & dosage; Postoperative Period; Prospective Studies; Sutures; Tonometry, Ocular; Trabeculectomy; Glaucoma; laser suture lysis; trabeculectomy
• ISSN: 1724-6016
• DOI: 10.1177/1120672120901699

To analyse the efficacy and safety of a standardized laser suture lysis protocol following trabeculectomy. Prospective interventional study conducted at a tertiary centre, between June 2016 and July 2017. Consecutive patients undergoing primary trabeculectomy with mitomycin C (0.4 mg/mL) for open angle glaucoma were enrolled. According to study protocol, a first laser suture lysis was performed routinely when intraocular pressure was greater than 10 mmHg, starting at postoperative day 8, and a second laser suture lysis was done whenever the intraocular pressure was newly greater than 10 mmHg, with a minimum interval of 1 week after the first laser suture lysis. Primary outcome was intraocular pressure (mean value, and mean difference from baseline in percentage). Safety parameters were also analysed. Thirty-three eyes of 28 patients (13 males) were enrolled with a mean age of 69.6 ± 15.1 years. Pre-operative intraocular pressure was 24.9 ± 8.6 mmHg. All eyes underwent a laser suture lysis before the 12th postoperative week, with a mean intraocular pressure-lowering efficacy of 42.4% (p < 0.01). A second laser suture lysis procedure, when performed (n = 14), had an additional intraocular pressure-lowering efficacy of 26.7% (p = 0.02). Mean intraocular pressure at 1-month follow-up was 12.9 ± 8.2 mmHg, and during this period, two cases of self-limited choroidal detachments were noticed. Ten patients needed additional bleb needling. Mean intraocular pressure at 1-year follow-up was 13.8 ± 8.0 mmHg under an average of 0.4 topical intraocular pressure-lowering drugs (p < 0.01). In our study, laser suture lysis was an effective tool to lower intraocular pressure during the early postoperative period, with an acceptable safety profile.