075649_SUTURELESS_TRABECULECTOMY_POSTER.ppt

Sutureless TrabeculectomyASCRS 2006

Author: Dr. Ashok P. Shroff, MDCo-authors: Dr. Hardik A. Shroff, MD, Dr. Dishita H. Shroff, MD

Shroff Eye Hospital, Near Railway StationNavsari – 396 445, Gujarat, India.

Phone (091) 2637 250565, 250695 Email: [email protected]

Demography Results

Complications

Procedure

Clinical ObservationsDiscussion

Introduction

I do not have any financial interest in this Presentation

Sugar (1961) first suggested partial thickness scleral flap over filtering channels as a treatment of glaucoma. But Cairns in 1968 made it popular as “Trabeculectomy”.

Since then, this procedure has undergone various modifications in term of thickness, size of flap, size of window, no of sutures, type of closure (loose or tight), adjustable sutures, etc.

However, the primary goal is to achieve adequate closure of the wound with early formation of anterior chamber and normalization of IOPr.

How could we think about this idea? Phacoemulsification through corneoscleral tunnel has been very

effective procedure particularly in earlier days when rigid PMMA lens were used.

At that time, cases needing phacotrab were treated through the same site in only one sitting with very good success and well control of IOPr.

This has given us the thought, why trabeculectomy cannot be modified to a sutureless technique?

Aim To study the efficacy of this procedure in cases of open angle

glaucoma in terms of anatomical success and control of IOPr and any complication.

Introduction

Procedure Fornix based conjunctival flap is

made Bleeding points are cauterized with

wet field diathermy 3-4mm long and about 2mm away

from the limbus, a partial thickness incision is made on the sclera (as made for corneoscleral tunnel for phaco)

A tunnel is formed with a crescent blade upto 1mm in cornea (4×3mm2) (corneoscleral tunnel as in phaco surgery)

One side-port incision is made in the limbus at 10 o’clock

A small window is made in the floor of the corneoscleral tunnel using a stab knife and corneal scissor / scleral punch

A PBI is made through that window Conjunctival flap is reposited and

the ends are closed with diathermy The anterior chamber is formed

with BSS and at the same time the bleb is also formed (Air can also be used to form AC)

7 eyes (10.94%) – Ciliochoroidal detachment 5 eyes (7.81%) – Corneal edema 11 eyes (17.19%) – Cataract enhancement

Demography

Total eyes – 64 All having

uncontrolled POAG due to- Non compliance Unaffordability Unavailability

23 males, 20 females Age – 46 to 69 years

(mean 53 years)

Complications

IOP was controlled 44 (68.75%) Eyes required

no drugs even after 1 year 8 (12.50%) Eyes required one

drug after 6 months 8 (12.50%) Eyes required two

drugs after 9 months IOP was not controlled in 4

(6.25%) eyes required repeat surgery after one year

Observations

Clinical Observations

Postoperative Well-formed Bleb

Combined Phacotrabeculectomy

Combined phacoemulsification & trabeculectomy can also be done sutureless through the same incision

The purpose of partial thickness scleral flap over filtering channel is served.

Procedure is easy Results suggest very good formation of blebs and well

control of IOP. Phacoemulsification with IOL can easily be done though the

same wound. All complications related to sutures can be avoided In real sense, the procedure can be called “sutureless”.

64 eyes of open angle glaucoma were successfully treated with sutureless trabeculectomy

Discussion

Summary