Novel sub-flap mattress suture with deep sclerectomy: Complications and modifications

Abstract

Recently, Abdelrahman et al. described a novel technique modifying deep sclerectomy (DS) surgery through placement of a non-absorbable mattress suture beneath the superficial scleral flap. 1 The authors reported superior IOP reduction with no complications, highlighting an effective and inexpensive way of replacing a spacer device.Our standard DS technique has been described extensively in previous publications. 2 The main differences from Abdelrahman et al. are the 5 × 4 mm 2 trapezoid, rather than 4 × 3 mm 2 rectangular, superficial scleral flap (Figure 1) and our use of a hydroxyethyl methacrylate spacer (EsnoperV2000 ® ). We similarly place the superficial flap back loosely with a single 10-0 nylon suture or none at all. We modified our standard technique by performing the proposed 10-0 nylon suture instead of the spacer device, without modifying the rest of our standard DS technique, in three consecutive cases. All surgeries were performed by the same experienced surgeon and patients had a minimum of 6 months follow-up.The first patient had a slow anterior leak day one postoperatively. This resolved without intervention within two weeks. IOP was 12 mmHg at week 2, and 17 mmHg at 6 months post-surgery. In the second case, a Seidel's test was performed intra-operatively and was positive. An additional conjunctival mattress suture was used to ensure a watertight bleb. IOP remained constant at 6-8 mmHg over the following 6 months. The third patient was Seidel's negative intraoperatively. However, a large subconjunctival bleb, hypotony (IOP 2 mmHg) and choroidal detachments with macular folds were found day one postoperatively. All hypotonous sequelae resolved within two weeks following cycloplegia and reduction in topical steroids. IOP was 10-12 mmHg in subsequent reviews.For all patients, VA post-operatively was stable when compared to pre-op, with a range of LogMAR 0.05-0.34 at 6 months post-op. None of our patients required laser goniopuncture (LGP) during the post-operative follow-up