Sutureless Trabeculectomy ASCRS 2006

1
Sutureless TrabeculectomyASCRS 2006

• Author Dr. Ashok P. Shroff, MD
• Co-authors Dr. Hardik A. Shroff, MD, Dr. Dishita
  H. Shroff, MD
• Shroff Eye Hospital, Near Railway Station
• Navsari 396 445, Gujarat, India.
• Phone [phone], 250695 Email
  sehnavsari_at_yahoo.co.in

Introduction
Demography Results Complications
Procedure
Clinical Observations
Discussion
I do not have any financial interest in this
Presentation
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Introduction

• Sugar (1961) first suggested partial thickness
  scleral flap over filtering channels as a
  treatment of glaucoma. But Cairns in 1968 made it
  popular as Trabeculectomy.
• Since then, this procedure has undergone various
  modifications in term of thickness, size of flap,
  size of window, no of sutures, type of closure
  (loose or tight), adjustable sutures, etc.
• However, the primary goal is to achieve adequate
  closure of the wound with early formation of
  anterior chamber and normalization of IOPr.

• How could we think about this idea?
• Phacoemulsification through corneoscleral tunnel
  has been very effective procedure particularly in
  earlier days when rigid PMMA lens were used.
• At that time, cases needing phacotrab were
  treated through the same site in only one sitting
  with very good success and well control of IOPr.
• This has given us the thought, why trabeculectomy
  cannot be modified to a sutureless technique?

• Aim
• To study the efficacy of this procedure in cases
  of open angle glaucoma in terms of anatomical
  success and control of IOPr and any complication.

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Procedure

• Fornix based conjunctival flap is made
• Bleeding points are cauterized with wet field
  diathermy
• 3-4mm long and about 2mm away from the limbus, a
  partial thickness incision is made on the sclera
  (as made for corneoscleral tunnel for phaco)
• A tunnel is formed with a crescent blade upto 1mm
  in cornea (43mm2) (corneoscleral tunnel as in
  phaco surgery)
• One side-port incision is made in the limbus at
  10 oclock
• A small window is made in the floor of the
  corneoscleral tunnel using a stab knife and
  corneal scissor / scleral punch
• A PBI is made through that window
• Conjunctival flap is reposited and the ends are
  closed with diathermy
• The anterior chamber is formed with BSS and at
  the same time the bleb is also formed (Air can
  also be used to form AC)

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Demography
Observations

• Total eyes 64
• All having uncontrolled POAG due to-
• Non compliance
• Unaffordability
• Unavailability
• 23 males, 20 females
• Age 46 to 69 years (mean 53 years)

• IOP was controlled
• 44 (68.75) Eyes required no drugs even after 1
  year
• 8 (12.50) Eyes required one drug after 6 months
• 8 (12.50) Eyes required two drugs after 9 months
• IOP was not controlled in 4 (6.25) eyes required
  repeat surgery after one year

Complications

• 7 eyes (10.94) Ciliochoroidal detachment
• 5 eyes (7.81) Corneal edema
• 11 eyes (17.19) Cataract enhancement

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Clinical Observations

• Combined phacoemulsification
  trabeculectomy can also be done sutureless
  through the same incision

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Discussion

• The purpose of partial thickness scleral flap
  over filtering channel is served.
• Procedure is easy
• Results suggest very good formation of blebs and
  well control of IOP.
• Phacoemulsification with IOL can easily be done
  though the same wound.
• All complications related to sutures can be
  avoided
• In real sense, the procedure can be called
  sutureless.

Summary

• 64 eyes of open angle glaucoma were successfully
  treated with sutureless trabeculectomy