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Outcomes of a Modified Trabeculectomy Closure Technique

Lee, Moon Jeong BS*; Bajaj, Rohan P. BS*; Mihailovic, Aleksandra MS*; Iyer, Jayant V. MD; Jampel, Henry D. MD, MHS*; Friedman, David S. MD, MPH, PhD*

doi: 10.1097/IJG.0000000000001263
Original Studies

Precis: A modified closure for trabeculectomy in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 nylon sutures, provided similar surgical outcomes to the standard trabeculectomy closure technique.

Purpose: To examine the surgical outcomes of a modified trabeculectomy closure technique in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 sutures, burying the posterior conjunctiva under an anterior lip of conjunctiva.

Materials and Methods: This retrospective review included 73 eyes that underwent trabeculectomies between 2015 and 2017 at Johns Hopkins Hospital by a single surgeon. We analyzed traditional closures used from January 2015 to May 2016, and modified closures used from July 2016 to March 2017. The main outcome measures were a reduction in intraocular pressure at 3, 6, and 12 months, reduction in the number of medications at 12 months, and total number of postoperative complications.

Results: There was no difference in reduction of intraocular pressure at 3 months (9.9±8.2 vs. 10.5±8.7 mm Hg), 6 months (10.8±9.6 vs. 10.6±8.3 mm Hg), or 12 months (12.2±8.9 vs. 10.0±9.3 mm Hg) in the standard (n=44) and modified groups (n=29), respectively. There was a similar reduction in the use of glaucoma medications in the standard group (1.2±1.5 vs. 1.0±1.1) compared with the modified group and no difference in the number of postoperative complications (25.0% vs. 17.2%, respectively) (P>0.05 for all).

Conclusions: The modified closure provided similar results to the standard closure for trabeculectomy. Further studies are needed to determine whether the 2 techniques differ in surgical outcomes over a longer follow-up or other surgical parameters (eg, ease, surgical time, learning curve).

*Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

Glaucoma Department, Singapore National Eye Center, Singapore, Singapore

M.J.L. and R.P.B. contributed equally (co-first authors).

Disclosure: The authors declare no conflict of interest.

Reprints: David S. Friedman, MD, MPH, PhD, Johns Hopkins Hospital, 600 N. Wolfe Street, Wilmer 120, Baltimore, MD 21287 (e-mail:

Received November 30, 2018

Accepted April 6, 2019

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