Sutureless tunnel trabeculectomy without peripheral iridectomy: a new modification of the conventional trabeculectomy

Abstract

The purpose of this study was to describe the results of a new modification of the trabeculectomy technique, sutureless tunnel trabeculectomy without peripheral iridectomy (PI), in a group of patients with chronic open-angle glaucoma (COAG). Patients with uncontrolled COAG who were candidates for trabeculectomy underwent sutureless tunnel trabeculectomy without PI. Patients were examined before surgery and at 1, 3, 6 and 12 months after surgery. Pre- and post-operative data including intraocular pressure (IOP), visual acuity, number of anti-glaucoma medications and intraoperative and post-operative complications were recorded. Surgical success was defined as final IOP < 21 mmHg and > 20 % reduction from baseline (criterion A) and as final IOP < 18 mmHg and > 25 % reduction from baseline (criterion B), without further glaucoma surgery or complications that required returning the patient to the operating room. Success was further classified as complete when these criteria were obtained without medications and qualified with or without medical therapy. Eighteen eyes of 18 patients were recruited into the study. All patients had 6 months of follow-up and 15 patients (83.3 %) completed 12 months of follow-up. Mean (SD) age of the patients was 57.2 (5.7) years. Mean (SD) IOP decreased from 23.7 (4.5) mmHg pre-operatively to 14.7 (3.4) mmHg at final follow-up visit (p < 0.001), and the mean (SD) number of glaucoma medications decreased from 2.89 (0.32) pre-operatively to 1 (0.84) at last visit (p < 0.001). Post-operatively, IOP and number of glaucoma medications were decreased in comparison with baseline at all follow-up visits (p < 0.001 for all visits). Qualified and complete surgical success rates were 78 and 50 % for criterion A, and 72 and 50 % for criterion B. Sutureless tunnel trabeculectomy without PI effectively reduced IOP and number of medications in COAG patients during 6-12 months of follow-up. Further controlled studies are needed to better characterize the safety and efficacy of this technique.

Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma

“…Tunnel trabeculectomies that use a scleral tunnel have been described in the past as a successful mode of filtration surgery [14–16]. These involve creating a triplanar scleral tunnel after raising a conjunctival flap.…”

A comparative study of a modified filtering trabeculotomy and conventional trabeculectomy

“…1 So far, numerous surgical 2 , 4 – 12 and postsurgical 13 , 14 variations have been described to improve its efficacy and safety while minimizing the risk of severe complications associated with filtering blebs. As glaucoma surgeons search for improvements to traditional filtering surgery, several modifications and new techniques of trab 15 – 23 have gained growing interest in clinical research. Moreover, a combination of a non-penetrating surgical approach and trab has previously been described – the combination of trab, trabeculotomy, and sinusotomy, aiming to lower IOP while reducing the risk of hypotony-related complications.…”

“…Recently, Eslami et al 15 published a modified method of sutureless tunnel trab without performing a PI to reduce intraoperative manipulation through the small scleral incision and iridectomy-related complications such as bleeding, inflammation, and cataract progression. They have shown that sutureless tunnel trab without PI is as effective in controlling IOP as it is with PI and reduces the rate of bleeding and excessive inflammation.…”

Retrospective evaluation of a filtering trabeculotomy in comparison to conventional trabeculectomy byexact matching

“…Numerous modifications have been explored over the years to reduce the rate of these. They include a smaller scleral flap (Ophir 2001) , limbus-versus fornix-based conjunctival closure (Solus et al 2012) , releasable flap sutures (Aykan et al 2007, Vuori & Viitanen 2001 , a combination of trabeculectomy with deep sclerectomy (Kayikcioglu, Emre & Kaya 2010) , different concentrations and exposure times of MMC (Bindlish et al 2002) or sutureless tunnel trabeculectomy without iridectomy (Eslami et al 2012) . The iridectomy that is part of traditional trabeculectomy with a trabecular block excision can cause hyphema, inflammation, posterior synechiae, iridodialysis, and cataracts (de Barros et al 2009, Grehn & Müller 1990 .…”