J Korean Ophthalmol Soc.  2013 Feb;54(2):272-279. 10.3341/jkos.2013.54.2.272.

The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

• Lee SJ
• Woo JM
• Kim SW
• An JH
• Yim JH

• KMID: 2216663
• DOI: http://doi.org/10.3341/jkos.2013.54.2.272

Abstract

PURPOSE
To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C.
METHODS
External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated.
RESULTS
The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 +/- 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 +/- 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed.
CONCLUSIONS
An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.

Keyword

External bandage suture; Hyperfiltration; Hypotony; Leakage; Trabeculectomy

MeSH Terms

Bandages
Blister
Conjunctiva
Humans
Incidence
Intraocular Pressure
Mitomycin
Sutures
Trabeculectomy
Visual Acuity
Mitomycin

Figure

• 

  Figure 1. The 43 year old male patient diagnosed with uveitic glaucoma and received trabeculectomy using mitomycin C as an adjuvant. Two weeks after the operation, the patient showed hyperfiltration bleb combined with hypotonic maculopathy (A). Funduscopic view showed tortuous retinal vessels with choroidal fold in the patient's hypotonic eye (B).

• 

  Figure 2. Schematic design of external bandage suture. In case with hyperfiltration, external bandage suture is designed to cross the scleral flap (A). In case with focal leakage, external bandage suture is designed to isolate leakage point with scleral flap (B). In case with hyperfiltration with severe chemosis, external bandage suture is designed to cross transversely from limbus to bleb margin, either 3 or 9 o'clock (C).

• 

  Figure 3. The procedure of external bandage suture in patient with hyperfiltration combined with hypotonic maculopathy (shown in Fig. 1). Under topical anesthesia, patient is directed to look downward. After recognized scleral flap region, external bandage suture is designed to cross scleral flap, and the tension of the suture is controlled by the surgeon. The procedure is performed from (A) to (D).

Reference

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