Bleb Compressive Sutures in the Management of Hypotony Maculopathy after Glaucoma Surgery

Abstract

PURPOSE: The aim of the study was to assess the efficacy and safety of compressive sutures in patients with hypotony maculopathy after glaucoma surgery. METHODS: This retrospective case series analyzes the clinical outcomes of conjunctival compressive sutures in 17 patients with hypotony maculopathy developed after glaucoma surgery. Compressive Nylon 10–0 single sutures were used in all patients; in two patients, the procedure was repeated. All patients underwent ophthalmic evaluation and macular OCT scanning before the surgery, one month, six months, and one year after the procedure. RESULTS: Mean intraocular pressure (IOP) before suturing was 2.3 ± 1.57 mmHg and increased to 14.2 ± 7.03 mmHg (p = 0.00065) one month after the procedure. After six months, mean IOP was 10.2 ± 4.3 mmHg (p = 0.005), and after one year ± 4.7 mmHg (p = 0.0117). To obtain the target pressure, the sutures had to be removed in one patient, and medical therapy was undertaken in three patients. Mean decimal best-corrected visual acuity (BCVA) before the sutures was 0.18 ± 0.13 and increased to 0.53 ± 0.25 (p = 0.0004) after one month, to 0.46 ± 0.31 (p = 0.005) after six months, and to 0.31 ± 0.22 (p = 0.025) after one year. In one case, leakage from the bleb was observed after the procedure and bleb revision was required. CONCLUSIONS: transconjuctival compressive sutures seem to be an efficient and safe technique for managing hypotony maculopathy after glaucoma surgery.

Gas Tamponade Improved Cilio-Choroidal Effusion Induced by an Ab Interno Trabeculotomy with a Microhook: Two Cases

“… 9 The reported rate of chronic hypotony caused by trabeculectomy is 1%–18%. 10 , 11 Yun et al stated that spontaneous recovery from hypotony occurred in 32.4% of a series of eyes with hypotony. 5 It remains very difficult to estimate the optimal timing of treatment for hypotony.…”

Management of an inadvertent late filtering bleb and hypotony in a scleral fixated intraocular lens implantation

“…Various methods including excision of the fistula and placement of compression sutures, conjunctival flaps, corneal patch grafts, partial thickness scleral flaps, scleral patch grafts, and with conjunctival advancement have been described. 13,14,15 In this case conservative management with BCL worked for some time, but progression of hypotony and worsening of visual acuity necessitated surgical management. Simple revision of the scleral wound with resuturing successfully closed the fistula without the need for a scleral patch graft as there was no scleral wall defect.…”

Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

“…Patients with high myopia are at a higher risk of developing ocular hypotony due to their thin scleral wall, which may result in potential leakage of aqueous humor from the scleral incision adjacent to the site of XEN gel stent insertion ( 39 ). Treatment options for hypotony after glaucoma surgery, mainly caused by over-filtrating blebs, include conservative management with topical autologous serum ( 40 ), transconjunctival compressive sutures ( 18 ), bleb injection of autologous blood ( 41 ) or viscoelastic material ( 42 ), as well as AC injection of viscoelastic material ( 43 ) or gas ( 44 ). Conservative management usually has minor and short-lasting effects.…”