Outcomes of Suturing Triangular Shaped Trabeculectomy Flap Using Single Versus Double Suture Techniques

Abstract

Background: A gold standard surgical technique, trabeculectomy is used in the management of glaucoma which is not controlled medically to lower the intraocular pressure (IOP) by creating a conduit via the sclera via which aqueous humor passes into the subconjunctival space through the anterior chamber. Objective: This study assesses the reduction in intraocular pressure (IOP) with two suturing techniques during trabeculectomy with a triangular shaped scleral flap. Method: This study was carried out from January 2019 to June 2019 at BHY Hospital, Karachi and engaged patients belonging to either gender between 40 to 60 years of age. Patients included had primary open angle glaucoma with IOP > 24 mmHg despite full medical treatment. Patients having other types of glaucoma or previous history of undergoing trabeculectomy were excluded from the study. Trabeculectomy with triangular shaped scleral flap was performed on patients of both the groups with the difference being the number of sutures placed and their site. In group A, flap was approximated using a single suture, applied at the apex of the triangular tip, whereas two sutures were passed in group B on each side of the triangle close to the flap apex. Results: The study comprised a total of twenty-four patients divided in two equal groups. Mean age was 49.3±3.61 years. Mean pre-operative IOP in all the patients was 26.9±1.48 mmHg whereas post-operative mean IOP at the end of follow up was 14.0±2.08mmHg in group A and 15.1±1.67mmHg in group B patients (p = 0.181). Two patients of group A reported hypotony in the immediate postoperative period which was managed conservatively where as one patient from group A and one patient from group B required revision surgery owing to episcleral fibrosis. Conclusion: Both techniques were found to be equally effective for lowering the IOP with similar minimal risk profile.