Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy

• Published in: Canadian journal of ophthalmology Vol. 44; no. 5; pp. 567 - 570
• Main Authors: Letartre, Laurence, MD, Basheikh, Ahmed, MD, Anctil, Jean-Louis, MD, FRCSC, Marchais, Béatrice Des, MD, FRCSC, Goyette, Annie, MD, FRCSC, Kasner, Oscar P., MD, FRCSC, Lajoie, Caroline, MD, FRCSC
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.10.2009
• Subjects: Adult; Aged; Aged, 80 and over; Aqueous Humor - secretion; Conjunctiva - surgery; Female; glaucoma; Glaucoma - surgery; Humans; hypotonia; Internal Medicine; Intraocular Pressure; Male; Middle Aged; Ocular Hypotension - etiology; Ocular Hypotension - metabolism; Ocular Hypotension - surgery; Ophthalmology; Retrospective Studies; Sclera - surgery; Surgical Flaps; Suture Techniques; trabeculectomy; Trabeculectomy - adverse effects; Visual Acuity; glaucoma; hypotonia; trabeculectomy
• ISSN: 0008-4182; 1715-3360
• DOI: 10.3129/i09-123

Abstract Objective: To assess the efficacy of transconjunctival suturing of the scleral flap in improving hypotony maculopathy resulting from overfiltration after trabeculectomy. Design: Retrospective review. Participants: 35 eyes of 33 patients. Methods: Patients underwent transconjunctival scleral flap suturing for hypotony maculopathy following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure using a spatulated needle with a 10-0 nylon suture. Results: The average age of the patients was 67.5 (SD 4.80, range 39–83) years, and 52% patients were male. The average duration of hypotony prior to transconjunctival suturing of the flap was 108.0 (SD 68.3) days. The median intraocular pressure (IOP) before suturing was 3 mm Hg, and the median IOP 6 months after the procedure was 9 mm Hg ( p < 0.0001). The median best-corrected visual acuity (BCVA) before transconjunctival suturing of the scleral flap was 20/100, and the median BCVA 6 months after the procedure was 20/30 ( p < 0.0001). Compared with visual acuity before suturing the average gain in BCVA was 4.9 (SD 0.8) lines. Conclusions: Transconjunctival suturing of the trabeculectomy scleral flap is an effective treatment to raise IOP and improve visual loss from hypotony maculopathy after trabeculectomy with overfiltering blebs.