Transconjunctival suturing techniques to treat over-filtration following trabeculectomy

Hypotony is a recognised complication following filtration surgery such as trabeculectomy (1). Where this is due to over-filtration, intervention may be required to reduce filtration and prevent long-term vision loss.

Transconjunctival suturing is one treatment option that avoids the need to open the conjunctiva. This is either in a direct manner with sutures passed through the scleral flap radially (2), or indirectly by placing the scleral passes distally on either side of the trabeculectomy flap to create a compressive effect over the flap (3). Sutures can be subsequently removed to increase flow or left in situ where they pass through the conjunctiva and end up in the subconjunctival space and are no longer exposed.

Contributor:* Jonathan Yu FRCOphth - Manchester Royal Eye Hospital, UK*

References:
1) Yun S, Chua B, Clement CI. Does Chronic Hypotony following Trabeculectomy Represent Treatment Failure? J Curr Glaucoma Pract. 2015 Jan-Apr; 9(1): 12–15. doi: 10.5005/jpjournals-10008-1176. Epub 2015 Jan 15.
2) Scoralick ALB, Almeida I, Ushida M, et al. Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract. 2017 May-Aug;11(2):58-62. doi: 10.5005/jp-journals-10028-1224. Epub 2017 Aug 5.
3) Yu J TS, Mercieca K, Au L. Conjunctival bleb compression sutures: An effective method of addressing hypotony after trabeculectomy or trabeculectomy-related procedures. Eur J Ophthalmol. 2018 Nov;28(6):731-734. doi: 10.1177/1120672118777100. Epub 2018 Jun 11.

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