A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative Hypotony

Autor: Philipp David Culmann, Esther M. Hoffmann, Franz Hermann Grus, Norbert Pfeiffer, Panagiotis Laspas, Verena Prokosch-Willing, Alicia Poplawksi
Rok vydání: 2016
Předmět:
Male
Intraocular pressure
Eye Diseases
genetic structures
medicine.medical_treatment
lcsh:Medicine
Glaucoma
Ocular Hypotension
Pathology and Laboratory Medicine
Vascular Medicine
Surgical Flaps
Cornea
Blister
Postoperative Complications
0302 clinical medicine
Medicine and Health Sciences
Glaucoma surgery
Trabeculectomy
lcsh:Science
Dry needling
Multidisciplinary
Ophthalmic Procedures
Middle Aged
Sclera
medicine.anatomical_structure
Female
Anatomy
Research Article
medicine.medical_specialty
Ocular Anatomy
Surgical and Invasive Medical Procedures
Hemorrhage
03 medical and health sciences
Signs and Symptoms
Musculoskeletal System Procedures
Adverse Reactions
Ocular System
Diagnostic Medicine
Ophthalmology
medicine
Humans
Bleb (cell biology)
Intraocular Pressure
Aged
Pharmacology
business.industry
lcsh:R
Biology and Life Sciences
medicine.disease
eye diseases
Surgery
030221 ophthalmology & optometry
lcsh:Q
sense organs
business
030217 neurology & neurosurgery
Zdroj: PLoS ONE
PLoS ONE, Vol 11, Iss 6, p e0157320 (2016)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0157320
Popis: Purpose A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly. Methods The study included two groups of 23 patients with failing bleb following trabeculectomy: “Group 1” underwent simple needling revision of the filtering bleb and served as a control group, while “Group 2” received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure (IOP), postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests. Results Adverse effects occurred with a higher frequency after sole needling of the bleb (5 cases of choroidal effusion and 1 case of choroidal hemorrhage) than after the combined method with additional scleral sutures (1 case of choroidal effusion). The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 (P = 0.01). Ten patients with ocular hypotony (IOD of 5 mmHg or lower) were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups (P>0.05). Conclusions This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage.
Databáze: OpenAIRE
Externí odkaz: