EPOS

European Paediatric Ophthalmological Society

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25 Releasable suture technique in filtration surgery for congenital glaucoma

Biswas, S., Nischal, K.
Great Ormond Street Hospital for Children, London

Purpose:To demonstrate a technique of undertaking paediatric glaucoma filtration surgery using a several mattress-type releasable sutures.

Methods:A retrospective look at 7 eyes of 6 paediatric patients with congenital and developmental glaucoma undergoing glaucoma drainage surgery in the form of trabeculectomy or trabeculotomy / trabeculectomy with or without concurrent 5-fluorouracil (5-FU) administration. In addition to 2 permanent 10-0 nylon sutures, all patients had at least 2 or more releasable 10-0 nylon sutures inserted to tightly secure the scleral flap. Selective removal of these sutures during the early follow up period was performed to modulate the IOP. This was accompanied by administration of further antimetabolite doses if required.

Results:The mean follow up was 9.67 months (range 3 - 18 months). Anterior chamber depth in the immediate post operative period was preserved in all but 2 patients, one of whom required anterior chamber reformation on the 2nd day post operatively. There were no cases of irido-corneal or irido-lenticular touch. No patient developed choroidal detachments and there were no cases of prolonged hypotony (IOP < 5 mmHg for > 1 month). There were no suture-related complications and release of sutures was not accompanied by further anterior chamber collapse. No 5-FU was observed to flow into the anterior chamber of the eye per-operatively when further 5-FU injections were administered. Mean pre-operative intra-ocular pressure (IOP) was 24.7 mmHg (range 19 - 40 mmHg) with a mean number of 2.9 antiglaucoma medications used, whilst post-operative IOP was 12.8 mmHg (range 9 - 21 mmHg) with a mean number of 0.4 antiglaucoma medications used. The reduction in IOP (average 13.8 mmHg) was significant (p<0.001; paired t-test).

Conclusion:The technique described here for placement of releasable sutures provides a means to prevent the early complications of filtration surgery related to prolonged hypotony. The sutures are well tolerated and can easily be released to allow good control of post-operative IOP and safe administration of antimetabolite.