A comparative study of sutureless scleral tunnel trabeculectomy versus conventional trabeculectomy in the management of primary open-angle glaucoma

Abstract

The aim of this study was to compare the outcome and complications of sutureless trabeculectomy with conventional trabeculectomy. A total of 52 eyes were randomly assigned to two groups. One group received standard conventional trabeculectomy and the other group received sutureless trabeculectomy. The patients were evaluated at 1, 3, 6 and 12 months after surgery. Patient data such as sex, age, intraocular pressure (IOP), logMAR visual acuity, antiglaucoma medications, and intraoperative and postoperative complications were collected and statistically analyzed. The mean age of the conventional and sutureless groups was 48.5 ± 15.4 and 57.3 ± 13.9 years, respectively. All patients achieved IOP levels <21 mmHg with a mean IOP of 13.4 ± 5.3 mmHg in the conventional group and 12.8 ± 2.6 mmHg in the sutureless group at 6 months and 11.00 ± 1.3 and 12.4 ± 3.2 mmHg at 12 months post surgery, respectively. These results showed a significant decrease compared to preoperative measures but did not show a significant difference between the two groups (p = 0.659). The number of antigalucoma medications used postoperatively showed a significant decline from preoperative status of 0.7 ± 0.58 in the conventional group and 0.4 ± 0.4 in the sutureless trabeculectomy group after 6 months and 0.68 ± 0.8 and 0.78 ± 0.9 after 12 months, respectively; however, there was no significant difference between the two groups (p = 0.112). No intraoperative complications were encountered in any of the groups. One patient in the sutureless trabeculectomy group developed mild hyphema which was managed medically. In the conventional group, two patients had failed trabeculectomy which was successfully revised, two patients showed hypotony 2 days after surgery which was managed medically and normal pressure was achieved within 5 days. Sutureless trabeculectomy appears to be a safe and easy method with results comparable to conventional trabeculectomy.

Medium-term Outcomes of Unsutured Scleral Flap Trabeculectomies

“…These include less traumatic manipulation of the eye, faster surgical procedural time, and better posterior aqueous flow, without the problem of postoperative overfiltration requiring additional interventions. 10 Potential explanations for the relatively low incidence of postoperative hypotony with sutureless trabeculectomies include the use of viscoelastic in the anterior chamber during surgery and subsequently the use of viscoelastic under the conjunctiva. The latter may provide a counterbalance to the intraocular pressure over the scleral flap, similar to that of an Ologen implant.…”