The impact of technique of conjunctive wound suturing during sinus trabeculectomy on the formation of the filter bleb and the hypotensive efficiency of the operation

Abstract

Purpose. To study how filtration blebs change in the postoperative period after applying the innovative patented suture during sinus trabeculectomy (STE).Material and methods. 105 patients (105 eyes) with primary open-angle glaucoma were randomized into 2 gender and age matched groups. In group 1, the conjunctival wound was sutured with separate continuous sutures on the conjunctiva and the Tenon's capsule. In group 2, the wound was sealed according to an innovative method. Before surgery, patients underwent a comprehensive examination, including visometry, tonometry, perimetry, and retinal tomography. In the postoperative period (1 day, 1, 2 weeks, 1, 3, 6 and 12 months after the STE), the changes of filtration blebs characteristics were assessed using the Würzburg bleb classification score (WBCS).Results. In group 2, one day after the surgery, IOP showed a decrease 0.8 mm Hg greater than in group 1. One month after surgery, the decrease was 1.5 mm Hg greater. The difference in IOP levels between the study groups persisted for up to 1 year (with a significant difference of 3.6 mm Hg after 3 months, and 3.8 mm Hg after 1 year, p = 0.001). The development of intraoperative and early postoperative complications was generally comparable. In group 1, an additional suture sealing was required in 11 8 % of cases due to external filtration. In group 2, no additional sutures were required (p = 0.01). The two groups revealed differences in the degree of vascularization of the conjunctiva and in the presence of conjunctival microcysts, as well as in the degree of encapsulation (p < 0.001) Group 2 treated by the innovative suturing technique showed better results.Conclusion. The innovative method of applying a sealing suture after STE quickens the normalization of the main characteristics of filtration blebs in comparison with the control group within 1 year after the intervention.

Keywords

• glaucoma
• trabeculectomy
• glaucoma surgery
• bleb
• würzburg clinical and morphological classification