Removable regulating sutures during trabeculectomy for a safer and more effective intraocular pressure control

Author:

Savastano Alfonso12,Maiola Emanuele13,Carlà Matteo Mario12ORCID,Gambini Gloria12ORCID,Boselli Francesco12,Giannuzzi Federico12,Rizzo Clara4ORCID,Rizzo Stanislao12

Affiliation:

1. Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, 00168 Rome, Italy

2. Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy

3. Catholic University “Sacro Cuore”, Faculty of Medicine and Surgery, Rome, Italy

4. Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy

Abstract

Purpose Comparing the effect of standard trabeculectomy with direct sutures versus trabeculectomy with compression and everting sutures. Methods Mono-centric randomized prospective comparative study on 38 glaucomatous eyes undergoing trabeculectomy: 19 with standard fixed sutures (group A) and 19 withremovable regulating sutures (group B). Preoperatively and at day-7, 1-month, 2-months, 3-months and 6-months after surgery, we recorded best-corrected visual acuity (BCVA), intraocular pressure (IOP) and possible complications. Complete, partial success and failure rates were recorded at the end of the study. Results In group B, we pulled everting sutures with the “horse bridle” technique at the 14th day, and successively removed all sutures between the 14th-30th post-operative day. At month-1, we recorded a significant IOP reduction in both groups (mean reduction of 11.5 mmHg for group A and of 14.4 mmHg for Group B, p = 0.001 and p < 0.0001, respectively). Furthermore, group B showed a significantly lower IOP than group A (−4.2 mmHg, 95% confidence interval [CI] −7.0 to −0.5 mmHg for group B, p = 0.01). At 2, 3 and 6-months, no significant IOP differences were reported between the two groups (all p > 0.05), but failure rate was higher for group A (21%) than for group B (11%). No differences in visual outcomes at any timepoints were noted. Conclusions Trabeculectomy with removable regulating sutures showed a good safety profile, comparable to standard trabeculectomy. Moreover, we reported a lower IOP one month postoperatively, suggesting this technique may optimize early management of trabeculectomy.

Publisher

SAGE Publications

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