Compression sutures with autologous blood injection for leaking trabeculectomy blebs

Biswas, Sayan; Zaheer, Irum; Monsalve, Blanca; Diamond, J P

doi:10.1136/bjo.2008.142497

Cited by 10 publications

(7 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Placing a suture at the end of the procedure to close the surgical wound reduces the amount of SIA. 1,2 This has been proven by an ongoing study of ours that is in press. We would also recommend to rather fashion a scleral tunnel from the temporal side than from superior as it has been shown to reduce the SIA significantly and improve access to the anterior segment.…”

Section: Scleral Tunnel Intraocular Lens Explantation: Commentmentioning

confidence: 58%

Scleral tunnel intraocular lens explantation: comment

2016

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

Scleral tunnel intraocular lens explantation: comment I read with interest the case series by van Zyl et al. where intraocular lense (IOL) explantation was achieved via sutureless long scleral tunnels fashioned as in manual small incision cataract surgery (MSICS). 1 I recently travelled overseas to learn MSICS. Upon my return to Australia, two cases of subluxated IOLs presented and I utilised scleral tunnelling for IOL explantation.Patient 1 had a sudden IOL dislocation 25 years after original cataract surgery. A three-piece IOL was found in the anterior vitreous and the capsular bag was not identifiable. A scleral tunnel was fashioned superiorly, and an anterior chamber (AC) entry was initially limited to one pass of the keratome to facilitate anterior vitrectomy and anteriorisation of the IOL while maintaining AC stability. After applying acetylcholine, the scleral tunnel was widened to facilitate IOL removal and permit implantation of an AC IOL. However, surgical peripheral iridectomy (PI) was difficult due to the length of the scleral tunnel and caused significant iris trauma. The resulting vitreous haemorrhage caused delayed visual rehabilitation. Upon clearance of the vitreous haemorrhage 3 months later, the patient saw 6/7.5 with À0.25 D DS. Surgically induced corneal astigmatism was 1.31 D.Patient 2 had cataract surgery more than 20 years ago complicated by PC rupture and retinal detachment necessitating pars plana vitrectomy. He received a sclera-fixated poly(methyl methacrylate) one-piece IOL 13 years ago, but one of the sutures broke causing subluxation. A neodymium-doped yttrium aluminium garnet laser PI was performed preoperatively. A scleral tunnel was fashioned, and anteriorisation of the IOL was successful after removing the other remaining suture. After removal of the IOL from the scleral tunnel, an AC IOL was implanted without surgical PI. Visual rehabilitation was rapid, and after 6 weeks, the patient achieved 6/9 with +0.5 D DS. Surgically induced astigmatism was 1.30 D.I agree with van Zyl et al. that IOL explantation via deep scleral tunnels provides several advantages over clear corneal incisions. Cutting or folding IOLs in the AC inherently possesses significant risk of injury to the endothelium, capsular bag and iris. Large rigid IOLs that cannot be cleaved intracamerally, such as in Patient 2 aforementioned, would require very large corneal incisions to remove, which means unstable ACs for long periods of time while suturing is being completed. The risks of vitreous loss, retinal detachment, suprachoroidal haemorrhage and endophthalmitis are increased while suturing with an unstable AC, and the amount of induced corneal astigmatism from such large wound would be considerable. The scleral tunnel allows removal of large IOLs without the need to cleave or fold them intracamerally, a more stable AC throughout the surgery and decreased operating time and corneal astigmatism because suturing is unnecessary.I found two practical points helpful. Firstly, after fashioning a scleral tunnel wide ...

show abstract

Section: Scleral Tunnel Intraocular Lens Explantation: Commentmentioning

confidence: 58%

Scleral tunnel intraocular lens explantation: comment

2016

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

“…The initial management of bleb dysaesthesia involves lubricants. Autologous blood and compression sutures have been described in the treatment of over‐filtrating, leaking and overhanging blebs . We report outcomes including patient satisfaction for symptomatic relief from bleb dysaesthesia that did not improve with the use of lubricants.…”

Section: Resultsmentioning

confidence: 99%

“…The use of this approach has been well described, and is reported to reduce bleb size and height . To this, we have added simple patient satisfaction data.…”

Section: Resultsmentioning

confidence: 99%

Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Begum

Bobat

Kirwan

2016

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

“…Autologous blood provides a source of trophic factors that induce migration and proliferation of adjacent fibroblasts, thereby promoting healing within the bleb [11]. A combination of autologous blood injection with compression sutures has been performed in overfiltering and leaking blebs [12,13], which maximized remodeling within the bleb and allowed for subsequent safe surgical removal.…”

Section: Discussionmentioning

confidence: 99%

Safe Excision of a Large Overhanging Cystic Bleb Following Autologous Blood Injection and Compression Suture

Ching

Yam

et al. 2013

Korean J Ophthalmol

View full text Add to dashboard Cite

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.

show abstract

Compression sutures with autologous blood injection for leaking trabeculectomy blebs

Cited by 10 publications

References 4 publications

Scleral tunnel intraocular lens explantation: comment

Scleral tunnel intraocular lens explantation: comment

Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Safe Excision of a Large Overhanging Cystic Bleb Following Autologous Blood Injection and Compression Suture

Contact Info

Product

Resources

About