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Early Efficacy and Complications of Releasable Sutures for Trabeculectomy in Primary Angle-closure Glaucoma: A Randomized Clinical Trial

Liang, Yuan B. MD, PhD*,†,‡; Feng, Mei Y. MD*,†; Meng, Hai L. MD§; Fan, Su J. MD; Wang, Xing MD; Xie, Li L. MD#; Yi, Peng MSc; Tang, Xin MD*,†; Wang, Ning L. MD, PhD*,†; Thomas, Ravi MD**

doi: 10.1097/IJG.0b013e31826981c9
Original Studies

Purpose: To compare the postoperative intraocular pressure (IOP) and incidence of early complications after trabeculectomy with releasable suture to standard trabeculectomy in Chinese patients with primary angle-closure glaucoma.

Patients and Methods: One hundred seventy-five patients diagnosed as primary angle-closure glaucoma with 6 clock-hours or more of peripheral anterior synechia were randomly allocated to 2 treatment groups: 87 underwent standard trabeculectomy (S group: 2 interrupted permanent sutures to the scleral flap) and 88 received trabeculectomy with 2 permanent and 2 releasable sutures (R group). The postoperative IOP and complications during the first 3 months after surgery were compared.

Results: One hundred seventy-one patients (97.7%) attended the 3-month visit. The IOP in the first week after trabeculectomy was significantly higher in the R group: day 1, 17.3±8.6 versus 12.7±6.0 mm Hg (P<0.001); day 3, 18.0±7.3 versus 12.9±6.3 mm Hg (P<0.001); day 7, 14.8±6.3 versus 12.0±4.9 mm Hg (P=0.001), but no difference was observed after the second week (P=0.659 to 0.753). The incidence of transient hypotony was higher in S group (20.4%) than the R group (9.1%) (P=0.046); hypotony recovered in 80.8% (21/26) within 1 week. There was no difference in the occurrence of shallow chamber, choroidal detachment, macular edema, additional surgery, or hyphema (P=0.56 to 1.0).

Conclusions: The technique of releasable sutures for trabeculectomy used in this study did not demonstrate significant advantages over standard trabeculectomy. Releasable sutures were associated with some decrease in visual acuity and increase in postoperative complaints.

*Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University

Beijing Ophthalmology & Visual Science Key Lab, Beijing

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong

§Anyang Eye Hospital, Anyang, Henan Province

Handan Eye Hospital, Handan, Hebei Province

Fushun Eye Hospital, Fushun, Liaoning Province

#Ophthalmology and Optometry Hospital, Chenzhou, Hunan Province, P.R. China

**Queensland Eye Institute, University of Queensland, Brisbane, Australia

Y.B.L. and M.Y.F. contributed equally.

Disclosure: Supported by National “Eleventh Five-Year” Science and Technology Program. The Ministry of Science and Technology of the P.R.C. Grant No. 2007BAI18B08. The authors declare no conflict of interest.

Reprints: Ning L. Wang, MD, PhD, Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, P.R. China (e-mails: hes2006@yahoo.com).

Received January 3, 2012

Accepted June 5, 2012

© 2014 by Lippincott Williams & Wilkins.