Application Of The Detachable Sutures Placed Outside The Scleral Flap In The Clinical Trabeculectomy

Aim: To investigate the application of the detachable sutures placed outside the scleral flap inthe clinical trabeculectomy,36cases (50eyes) with glaucoma patients admitted to our hospitalophthalmology from December2010to June2013were observed and the clinical data was analyzedretrospectively.Methods:36(50eyes) hospitalized glaucoma patients from December2010to June2013were investigated retrospectively among them with male20cases and female16cases, which the age is from28to85years and the mean age (61.3±10.4). Based onmodus operandi, these patients were randomly divided into two groups: experimental groupand control group. The experimental group patients were given the treatment of detachablesutures placed outside the scleral flap in the clinical trabeculectomy. Routinedisinfection, the ball anesthesia, open eyelid, made conjunctival flap, the base of theconjunctival flap face the limbus or servedfornix, bleeding by burning scleral surface,do lamellar scleral flap, the base of the lamellar scleral flap is the limbus, the size is4mm×4mm. Do a puncture point into the anterior chamber in3:00or9:00limbus.Resection2mm×1mm trabecular tissu, which includes deep corneoscleral trabeculartissue, then cut the peripheral iris. Using10-0nylon suture, suture a needle on eachcorner of both sides of the scleral flap, made an "U" shaped suture on each sides of thescleral flap incision, which can be effectively adjusted. Made a slipknot with theretaining suture ends out side the Scleral flap, inject the Ringer’s solution from thecorneal puncture, so that the anterior is restored effectively. After the surgery,we check the filtration conditions of the scleral flap and anterior chamber depth carefully, adjustthe tightness of the suture to maintain proper tightness. Stitch tenon3-pin, andcontinuous suture the bulbar conjunctiva. The20,000U gentamicin+2.5mgdexamethasone inject into the subconjunctival and then Coated with ointment tocomplete the operation. The patients of the control group were given conventionaltrabeculectomy, without the detachable sutures placed outside the scleral flap in theclinical trabeculectomy. The intraocular pressure (IOP) with patients of two groups weremeasured at the preoperative and postoperative one week, six months. The anterior chamberand the bleb situation were observed after operation.Result: Differences of the patient’s IOP of the two groups at the preoperative andpostoperative one week was not significant (P>0.05); IOP of the experimental group weresignificantly lower than that of the control group at the postoperative six months (P <0.05).Postoperative anterior chamber: According to Spaeth classification the shallowanterior chamber was classified to degree I, Ⅱ, Ⅲ. no eye in the experimental groupoccurred Ⅱ or Ⅲ degree shallow anterior chamber, shallow anterior chamberincidence is0.0%(0/25).2eyes in the control group occurred I degree shallowanterior,1eye occurred Ⅱ degree shallow anterior chamber, no eye occurred Ⅱor Ⅲdegree shallow anterior chamber, shallow anterior chamber incidence is12.0%(3/25),at the preoperative and postoperative one week the differences of the patient’s shallowanterior chamber incidence between two groups was significant (P <0.05)Postoperative bleb: According to Kronfeld, Postoperative bleb is classified Ⅳtypes,type I and type Ⅱ are functional blebs. type Ⅲ, Ⅳ are non-functional blebs.There are80.0%(20/25) functional blebs in the experimental group and for the controlgroup,there are68.0%(17/25). The differences between the two groups was statisticallysignificant (P <0.05).Conclusion:The patient’s IOP was decreased, and the incidence of functional bleb wasincreased significantly, and the shallow anterior chamber was lower after trabeculectomy with the detachable sutures placed outside the scleral flap. Above resultsshow that the effect of the trabeculectomy with the detachable sutures placed outside thescleral flap in the clinical application is good and worthy of the expansion.