A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative HypotonyReportar como inadecuado




A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative Hypotony - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Purpose

A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly.

Methods

The study included two groups of 23 patients with failing bleb following trabeculectomy: -Group 1- underwent simple needling revision of the filtering bleb and served as a control group, while -Group 2- received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure IOP, postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests.

Results

Adverse effects occurred with a higher frequency after sole needling of the bleb 5 cases of choroidal effusion and 1 case of choroidal hemorrhage than after the combined method with additional scleral sutures 1 case of choroidal effusion. The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 P = 0.01. Ten patients with ocular hypotony IOD of 5 mmHg or lower were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups P>0.05.

Conclusions

This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage.



Autor: Panagiotis Laspas , Philipp David Culmann, Franz Hermann Grus, Verena Prokosch-Willing, Alicia Poplawksi, Norbert Pfeiffer, Esthe

Fuente: http://plos.srce.hr/



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