Influence of Conjunctival Suture Removal on the Outcome of Trabeculectomy

Abstract

Background: To evaluate the influence of early conjunctival suture removal following trabeculectomy on postoperative outcome. Methods: In a prospective randomized clinical trial 73 eyes of 69 consecutive patients eligible for primary trabeculectomy were included in the study. Eyes were randomly assigned to a control or intervention group. Trabeculectomy was performed with a fornix-based conjunctival flap and a conjunctival running mattress-suture. In the intervention group, the conjunctival suture was removed 4 weeks postoperatively, in the control group the suture remained in place. Both groups were followed for up to 12 months and best corrected visual acuity (BCVA), refraction, corneal topography, intraocular pressure (IOP), anterior segment and fundus were assessed preoperatively and within a week, 1, 3, 6 and 12 months after surgery. Statistical analysis was performed using SPSS for Windows (t test for independent samples). Results: Trabeculectomy induced similar astigmatism in both groups. Compared to the control group, suture removal seemed to improve BCVA at 6 and 12 months. This was associated with a significantly lower IOP at 6 and 12 months and a significantly higher complete success rate at 12 months (94 vs. 65%, p < 0.001). Astigmatism was not significantly altered by suture removal. Conclusion: Conjunctival suture material appears to hamper trabeculectomy success and postoperative visual acuity. This is independent of postoperative astigmatism. Early removal of conjunctival sutures is advisable.

The Prognostic Value of the Wuerzburg Bleb Classification Score for the Outcome of Trabeculectomy

“…The baseline characteristics, the use of intra-operative antimetabolites, the frequency of postoperative 5-FU application, IOP, medication and outcome after 12 months of our study were similar to other studies [2,17,18]. The total bleb score increased continuously during follow-up as did the parameters vascularity, corkscrew vessels and microcysts.…”

Trabeculectomy With Moorfields Conjunctival Closure Technique Offers Safety Without Astigmatism Induction

“…Researchers found no statistical significant difference on the measured changes in corneal curvature between patients with or without early suture removal, whereas others did see a decline in surgical-induced astigmatism. 21,22 Furthermore, this study was not designed to investigate the effect of suture removal (either corneal or scleral) on surgical-induced astigmatism. Corneal curvature measurements were performed at month 1 postoperative the earliest, whereas 85.7% of scleral flap suture lyses were done in the first 2 weeks and all corneal sutures remained in place.…”

Inhibition of Monocyte Chemoattractant Protein 1 Prevents Conjunctival Fibrosis in an Experimental Model of Glaucoma Filtration Surgery

“…Sustained IOP reduction depends on the preservation of a functional, healthy bleb, which facilitates effective aqueous humor egress into the subconjunctival space following surgery. Surgical failure has been reported in between 35% and 43% [32][33][34] of cases, however, due to postoperative scarring and subconjunctival fibrosis. Adjunctive treatment with antiproliferative agents such as MMC or 5-FU is widely used by ophthalmic surgeons to prevent scarring and bleb failure, although these efforts to dampen fibrosis have a broad impact on tissue health and can lead to thin-walled blebs with risk of bleb leak and infection.…”