The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

Sung Ju Lee; Je Moon Woo; Sang Woo Kim; Jae Hwan An; Jin Ho Yim

doi:10.3341/jkos.2013.54.2.272

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Lee, Woo, Kim, An, and Yim: The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

Original Article

J Korean Ophthalmol Soc 2007;54(2):272-279.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.272

The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

Sung Ju Lee, MD, Je Moon Woo, MD, PhD, Sang Woo Kim, MD, Jae Hwan An, MD, Jin Ho Yim, MD

Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea

Address reprint requests to Jin Ho Yim, MD Department of Ophthalmology, Ulsan University Hospital #877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 682-714, Korea Tel: 82-52-250-7170, Fax: 82-52-250-7174, E-mail: yimjinho@hanmail.net

Received 15 June 201215 October 2012 Accepted 20 December 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C.

Methods

External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated.

Results

The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 ± 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 ± 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed. Conclusions: An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.

Keywords: External bandage suture, Hyperfiltration, Hypotony, Leakage, Trabeculectomy

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Figure 1.

The 43 year old male patient diagnosed with uveitic glaucoma and received trabeculectomy using mitomycin C as an adjuvant. Two weeks after the operation, the patient showed hyperfiltration bleb combined with hypotonic maculopathy (A). Funduscopic view showed tortuous retinal vessels with choroidal fold in the patient's hypotonic eye (B).

Figure 2.

Schematic design of external bandage suture. In case with hyperfiltration, external bandage suture is designed to cross the scleral flap (A). In case with focal leakage, external bandage suture is designed to isolate leakage point with scleral flap (B). In case with hyperfiltration with severe chemosis, external bandage suture is designed to cross transversely from limbus to bleb margin, either 3 or 9 o'clock (C).

Figure 3.

The procedure of external bandage suture in patient with hyperfiltration combined with hypotonic maculopathy (shown in Fig. 1). Under topical anesthesia, patient is directed to look downward. After recognized scleral flap region, external bandage suture is designed to cross scleral flap, and the tension of the suture is controlled by the surgeon. The procedure is performed from (A) to (D).

Table 1.

Baseline demographics of the study population

Patients	Age (years)	Gender	Eye	Type of glaucoma	Type of surgery	Cause of mattress suture	Hypotony maculopathy
1	48	M	OS	Uveitic glaucoma	TRAB	Hyperfiltration	+
2	27	F	OD	Congenital glaucoma	TRAB	Pinpoint leakage	−
3	49	M	OD	POAG	TRAB	Pinpoint leakage	+
4	33	M	OD	NVG	Triple	Severe chemosis	−
5	67	M	OD	NVG	TRAB	Severe chemosis	−
6	59	M	OD	POAG	TRAB	Pinpoint leakage	−
7	81	F	OS	Uveitic glaucoma	TRAB	Hyperfiltration	−
8	48	M	OS	POAG	TRAB	Pinpoint leakage	−
9	45	M	OD	Uveitic glaucoma	TRAB	Pinpoint leakage	−
10	43	M	OS	Uveitic glaucoma	Triple	Hyperfiltration	+

M = Male; F = Female; POAG = primary open-angle glaucoma; NVG = neovascular glaucoma; TRAB = trabeculectomy; Triple = trabeculectomy combined with cataract surgery.

Table 2.

IOP and BCVA of 10 eyes before and 1 month after mattress suture

	IOP (mm Hg)		BCVA (log MAR)
Patient	Before suture	1 month after suture	Before suture	1 month after suture
1	4	6	0.8	0.4
2	5	20	0.8	0.8
3	5	10	1.2	0.7
4	9	14	1.5	2.0
5	4	12	0.8	0.5
6	3	4	1.1	1.2
7	6	22	2.3	2.0
8	6	14	0.2	0.2
9	8	32	0.3	0.1
10	8	7	0.3	0.3

IOP = intraocular pressure; BCVA = best corrected visual acuity.

Table 3.

Comparison of IOP and BCVA of 10 eyes before and 1 month after mattress suture

Characteristic		Mean	p-value*
IOP (mm Hg [range])	Before suture	5.8 ± 2.0 (3.0-9.0)	0.008
	1 month after suture	14.1 ± 8.5 (4.0-32.0)
BCVA (log MAR [range])	Before suture	0.93 ± 0.64 (0.2-2.3)	0.31
	1 month after suture	0.81 ± 0.70 (0.1-2.0)

Values are presented as mean ± SD.

IOP = intraocular pressure; BCVA = best corrected visual acuity.

^* p-values are from Wilcoxon signed-rank test.

Table 4.

Outcomes for 10 eyes after external bandage suture, corrected with age, sex, type of flap, diagnosis and cause of suture

Characteristic		n	IOP after suture (mm Hg)	BCVA after suture (log MAR)	Gain in BCVA (lines)
Age (years)	<60	8	13.37 ± 9.15	0.71 ± 0.63	2.0 ± 2.2
	≥60	2	17.0 ± 7.07	1.2 ± 1.13	2.0 ± 1.4
Sex	Male	8	12.37 ± 8.75	0.66 ± 0.64	2.4 ± 2.1
	Female	2	21.0 ± 1.41	1.4 ± 0.85	0.5 ± 0.7
Type of bleb	Early functioning flap	8	14.37 ± 8.38	0.61 ± 0.61	2.38 ± 2.07
	Late avascular flap	2	13.0 ± 12.73	1.60 ± 0.57	0.50 ± 0.71
Diagnosis	POAG	3	12.5 ± 7.55	1.03 ± 0.77	2.25 ± 2.63
	Uveitis glaucoma	4	15.0 ± 14.7	0.27 ± 0.15	2.33 ± 2.08
	NVG	2	13.0 ± 1.41	1.20 ± 1.13	2.0 ± 1.41
	Congenital glaucoma	1	20	0.8	0
Cause of suture	Hyperfiltration	3	14.0 ± 8.0	1.47 ± 0.92	2.0 ± 1.73
	Focal leakage	5	16.0 ± 1.68	0.60 ± 0.45	2.20 ± 2.49
	Excess chemosis	2	9.5 ± 3.54	0.35 ± 0.07	2.0 ± 2.0

Values are presented as mean ± SD.

Mann-Whitney U test and Krunskal wallis test was done. All of the p-values were more than 0.05.

IOP = intraocular pressure; BCVA = best corrected visual acuity; POAG = primary open-angle glaucoma; NVG = neovascular glaucoma.

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