Department of Ophthalmology GMC, Anantnag, Jammu and Kashmir, India.
AIIMS New Delhi, India.
Rom J Ophthalmol. 2021 Jan-Mar;65(1):54-58. doi: 10.22336/rjo.2021.10.
To compare the outcome of fixed suture trabeculectomy with releasable suture trabeculectomy in terms of IOP control, bleb morphology, complications and need of antiglaucoma medication post-surgery. This study enlisted 200 cases of open angle glaucoma, whose IOP was uncontrolled despite maximal medication. Trabeculectomy was performed using releasable suture in one group of 100 patients and fixed suture in another group of 100 with mitomycin 0.02% in both groups. The study was randomized, the method being the simple randomization. Fornix based trabeculectomy was done in both groups. Two 10-0 nylon releasable sutures were used at two corners of the rectangular flap and one fixed 10-0 vicryl suture was used in the center of the flap. Two mattress sutures (conjunctiva cornea) were also used. Essentially, all the sutures were removed postoperatively over a period of 2-4 weeks depending upon the level of IOP. Mitomycin c 0.02% was used in both groups. The mean preoperative intraocular pressure was 33 ± 12 mmHg in the single suture group and 39 ± 13 mmHg in the releasable suture group (p). We observed a highly significant reduction of intraocular pressure at all times in both groups compared with the preoperative intraocular pressure (P, 0.0001). There was an obvious difference between the bleb morphology between conventional trabeculectomy and releasable suture trabeculectomy. Blebs in releasable suture trabeculectomy were more diffuse, low lying and presented a more ideal vascularity. Releasable suture trabeculectomy is a far much better technique than conventional trabeculectomy. Results are very good in terms of IOP control, post-operative complications, and bleb morphology. They may possibly have a role in wound modulation thereby achieving an ideal bleb, though more large sample studies need to be done.
比较固定缝线小梁切除术与可松解缝线小梁切除术在眼压控制、滤过泡形态、并发症和术后抗青光眼药物需求方面的结果。这项研究纳入了 200 例开角型青光眼患者，这些患者尽管使用了最大剂量的药物治疗，但眼压仍无法控制。一组 100 例患者行可松解缝线小梁切除术，另一组 100 例患者行固定缝线小梁切除术，两组均使用 0.02%丝裂霉素。该研究为随机对照研究，采用简单随机分组方法。两组均行穹窿部为基底的小梁切除术。在矩形瓣的两个角上使用两根 10-0 尼龙可松解缝线，在瓣的中心使用一根固定的 10-0 薇乔缝线。还使用了两针褥式缝线（结膜角膜）。基本上，所有缝线都根据眼压水平在 2-4 周内被拆除。两组均使用 0.02%丝裂霉素 C。单缝线组术前平均眼压为 33±12mmHg，可松解缝线组为 39±13mmHg（P）。与术前眼压相比，两组眼压均有显著下降（P<0.0001）。传统小梁切除术与可松解缝线小梁切除术的滤过泡形态有明显差异。可松解缝线小梁切除术的滤过泡更弥散、位置更低，呈现出更理想的血管化。可松解缝线小梁切除术是一种比传统小梁切除术更好的技术。在眼压控制、术后并发症和滤过泡形态方面，结果非常好。它们可能在伤口调节方面发挥作用，从而达到理想的滤过泡，尽管需要进行更多的大样本研究。
