Sutureless Trabeculectomy

ASCRS 2006
Author: Dr. Ashok P. Shroff, MD Co-authors: Dr. Hardik A. Shroff, MD, Dr. Dishita H. Shroff, MD
Shroff Eye Hospital, Near Railway Station Navsari 396 445, Gujarat, India. Phone (091) 2637 250565, 250695 Email: sehnavsari@yahoo.co.in

Introduction Procedure Clinical Observations

Demography Results Complications

Discussion

I do not have any financial interest in this Presentation

Introduction

Sugar (1961) first suggested partial thickness scleral flap over filtering channels as a treatment of glaucoma. But Cairns in 1968 made it popular as Trabeculectomy. Since then, this procedure has undergone various modifications in term of thickness, size of flap, size of window, no of sutures, type of closure (loose or tight), adjustable sutures, etc. However, the primary goal is to achieve adequate closure of the wound with early formation of anterior chamber and normalization of IOPr.

How could we think about this idea?

Phacoemulsification through corneoscleral tunnel has been very effective procedure particularly in earlier days when rigid PMMA lens were used. At that time, cases needing phacotrab were treated through the same site in only one sitting with very good success and well control of IOPr. This has given us the thought, why trabeculectomy cannot be modified to a sutureless technique?
To study the efficacy of this procedure in cases of open angle glaucoma in terms of anatomical success and control of IOPr and any complication.

Aim

Procedure

Fornix based conjunctival flap is made Bleeding points are cauterized with wet field diathermy 3-4mm long and about 2mm away from the limbus, a partial thickness incision is made on the sclera (as made for corneoscleral tunnel for phaco) A tunnel is formed with a crescent blade upto 1mm in cornea (43mm2) (corneoscleral tunnel as in phaco surgery) One side-port incision is made in the limbus at 10 oclock A small window is made in the floor of the corneoscleral tunnel using a stab knife and corneal scissor / scleral punch A PBI is made through that window Conjunctival flap is reposited and the ends are closed with diathermy The anterior chamber is formed with BSS and at the same time the bleb is also formed (Air can also be used to form AC)

Demography

Observations

Total eyes 64 All having uncontrolled POAG due to Non compliance Unaffordability Unavailability 23 males, 20 females Age 46 to 69 years (mean 53 years)

IOP was controlled

44 (68.75%) Eyes required no drugs even after 1 year 8 (12.50%) Eyes required one drug after 6 months 8 (12.50%) Eyes required two drugs after 9 months

IOP was not controlled in 4 (6.25%) eyes required repeat surgery after one year

Complications

7 eyes (10.94%) Ciliochoroidal detachment 5 eyes (7.81%) Corneal edema 11 eyes (17.19%) Cataract enhancement

Clinical Observations

Postoperative

Well-formed Bleb

Combined phacoemulsification & trabeculectomy can also be done sutureless through the same incision

Combined Phacotrabeculectomy

Discussion

The purpose of partial thickness scleral flap over filtering channel is served. Procedure is easy Results suggest very good formation of blebs and well control of IOP. Phacoemulsification with IOL can easily be done though the same wound. All complications related to sutures can be avoided In real sense, the procedure can be called sutureless.

Summary

64 eyes of open angle glaucoma were successfully treated with sutureless trabeculectomy