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Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow-ups and management of the blebs play a critical role in the long-term success. This video is aimed at showing the real-world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture-related complications and their management have been shown along with practical examples. Video Link: https://youtu.be/2WFQJAPyOvY

Purpose of the study was to evaluate the impact of «tight fixation» of a scleral flap with the subsequent performance of the laser suture lysis on the morphogenesis of established outflow pathways and hypotensive efficacy of trabeculectomy.Material and methods. This is a retrospective study. Seventy eyes of patients underwent trabeculectomy and LSL 1–1.5 months after it were under observation for 24 months. Comparison groups are determined by the presence of inadequate reparative regeneration syndrome. Technical nuances of trabeculectomy («tight» closure of the scleral flap) were evaluated using optical coherence tomography. The effect of LSL on the remodeling of outflow pathways was evaluated by ultrasound biomicroscopy. In the first group (n = 22) LSL was as a mechanical adjuvant treatment, in the second (n = 48) – as an adjuvant option. Ophthalmic tonus was evaluated by Maklakov (Pt) in mm Hg. The indices were estimated using Sstudent’s t-test, p < 0.05 was considered statistically significant.Results and discussion. The «tight» fixation of the scleral flap minimized early postoperative complications and did not detect Pt difference in the groups. LSL led to an increase in the height of the intrascleral channel and scan height in both groups (p < 0.01). After 24 months, complete hypotensive success was 95.5 % in the 1st and 81.25 % in the 2nd group, qualified – 4.5 and 18.75 %, respectively (p < 0.01). Despite the difference in IOP achieved: 15.3 ± 1.9 mm Hg. after 12 months, 15.1 ± 1.2 mm Hg. after 24 months in in group 2 (p < 0.01), more postoperative interventions in group 2 (p < 0.01), the results of complete and qualified success in the second group were high.Conclusion. The introduction of LSL in clinical practice can improve the effectiveness of glaucomatous fistulizing operations. The use of the technique of «tight» fixation of the scleral flap and the planned implementation of LSL are an example of multimodal approaches to minimize the number of early postoperative complications and increase the hypotensive efficiency of trabeculectomy.

Naoki Tojo, Mitsuya Otsuka, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Purpose: To compare the postoperative interventions and outcomes between conventional trabeculectomy and trabeculectomy with the Ex-PRESS® mini-glaucoma shunt device (Ex-Press).Methods: This was a retrospective, comparative, single-facility study. We analyzed the cases of 108 glaucoma patients who underwent trabeculectomy and were followed for >1 year. Thirty-nine eyes underwent a conventional trabeculectomy (conventional group) and 69 eyes underwent a trabeculectomy with an Ex-Press (Ex-Press group). As evaluation items, we examined postoperative intraocular pressure (IOP), the surgical success rate, postoperative complications, the number of days to laser suture lysis, and needling.Results: Trabeculectomy significantly decreased the patients’ IOP values from 27.8±7.9 to 11.1±3.9 mmHg in the conventional group (p

AIM: To evaluate the changes in intraocular pressure(IOP)after laser suture lysis after trabeculectomy associated with 5-Fluoroaracil and the correlate the effect in relation to the time of laser suture lysis.METHODS: Prospective interventional study of sixty eyes of sixty patients. Trabeculectomy associated with 5-Fluoroaracil was performed for 60 patients with glaucoma. Laser suture lysis was carried out according to the IOP of post trabeculectomy. 21mmHg was used as the cut off for the achievement of target IOP. According to the timing of laser suture lysis, patients post trabeculectomy were divided into three groups: 4wk.RESULTS: The differences of IOP prelaser suture lysis showed no statistical significance among three groups(P=0.999). The difference of IOP following 12wk post laser suture lysis showed significant statistical significance(PPtrend=0.069).CONCLUSION: Laser suture lysis during 2nd-4th week post trabeculectomy associated with 5-Fluoroaracil is an effective and safe technique for reducing IOP.

Purpose: To share our combined phacotrabeculectomy (PT) results and to evaluate the effectiveness and reliability of this procedure together with that of laser suture lysis (LSL) for postoperative early intraocular pressure (IOP) control after combined PT. Materials and Methods: This retrospective study evaluated the 33 eyes of 30 patients who had undergone combined PT. The age, gender, glaucoma type, preoperative and postoperative best corrected visual acuity (BCVA), number of antiglaucomatous drugs, IOP, surgical complications, early postoperative LSL requirement, IOP changes after LSL, and complications after LSL were investigated. Results: There were 18 male and 12 female patients with a mean age of 68.64±9.27 (40-86) years. The preoperative glaucoma type was most commonly pseudoexfoliative glaucoma as seen in 14 eyes and primary open angle glaucoma as seen in 12 eyes. The IOP was significantly lower (p<0.0001) and the BCVA significantly better (p<0.0001) postoperatively compared to the preoperative values. Similarly, the need for antiglaucoma drugs decreased postoperatively (p<0.0001). Postoperative LSL was required once in 12 eyes and twice in 4 eyes. Preoperative mean IOP was 26.75±5.4 mmHg and postoperative mean IOP was 11.31±2.96 mmHg in the eyes that underwent LSL (p<0.0001). No complications that threatened vision or affected surgical success were seen after LSL. Conclusion: Combined phacotrabeculectomy is an effective and reliable surgical method in cases with glaucoma and cataract together. Suture lysis with the argon laser is an effective and reliable method in the early period to achieve target intraocular pressure after phacotrabeculectomy, and can be performed multiple times. [ABSTRACT FROM AUTHOR]

Context: Laser suture lysis is used to enhance filtration after trabeculectomy. Aims: The aim of this is to evaluate the change in intraocular pressure (IOP) after laser suture lysis after trabeculectomy with mitomycin-C and to correlate the efficacy of suture lysis in relation to the time of lysis. Settings and Design: Prospective interventional study of seventy eyes of seventy patients. Subjects and Methods: Trabeculectomy with mitomycin-C was performed for 352 patients with glaucoma. Laser suture lysis was carried out when indicated for seventy patients during 2 nd -8 th week posttrabeculectomy. Primary outcome measures were IOP at immediate postsuture lysis, 1, 2, 4, 6, and 8 weeks, 3 and 6 months following laser suture lysis. For the purpose of statistical analysis, patients were divided into three groups depending on the week of suture lysis as 5 weeks posttrabeculectomy and 21 mmHg was used as the cutoff for the achievement of target IOP. Statistical Analysis Used: Descriptive statistical analysis has been carried out. Significance is assessed at 5% level of significance. Student′s t-test (two-tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups. Chi-square/Fisher exact test has been used to find the significance of study parameters on categorical scale between two or more groups. Results: On immediate postsuture lysis, 62 patients (88.6%) had IOP of

Objective: To evaluate the effectiveness of laser suture lysis (LSL) in patients with early high intraocular pressure (IOP) after trabeculectomy. Material and Methods: Fourty seven eyes of 42 patients who had high IOP and bleb formation after ocular massage in early postoperative period after trabeculectomy and undergone LSL between 2005 and 2013 were evaluated resrospectively. Results: Twenty-two patients were female, 20 patients were male and the mean age was 62.1±16 (34-81). LSL was performed once in 22 eyes (46.8%) and more than once in 25 eyes(53.2%). The mean number of LSL was 1.63±0.7. The mean IOP before trabeculectomy was 30.2 mmHg and it was 24.1±6.3 mmHg (14-42 mmHg) before LSL. The mean interval time between trabeculectomy and performance of suture lysis was 7.9±6.3 days. The mean IOPs before and immediately after laser suture lysis were 24.15±6.93 mmHg and 17.47±5.81 mmHg respectively in patients that LSL was performed once (p<0.001). The mean IOPs before and immediately after laser suture lysis were 23.96±7 mmHg and 16.6±4.61 mmHg respectively in patients that LSL was performed more than once (p<0.001). The difference was statistically significant in two groups (p<0.001). At the last visit, the mean IOP was 14.6±4.07 mmHg (4-25 mmHg) (p<0.001). The mean follow-up time was 21.4±20.01months (1-89 months). Conclusion: Laser suture lysis is a safe and effective method in the management of the patients in whom the target IOP was not reached after trabeculectomy and it can be performed more than once. [ABSTRACT FROM AUTHOR]

Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow-ups and management of the blebs play a critical role in the long-term success. This video is aimed at showing the real-world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture-related complications and their management have been shown along with practical examples. Video Link: https://youtu. be/2WFQJAPyOvY [ABSTRACT FROM AUTHOR]

Context: Laser suture lysis is used to enhance filtration after trabeculectomy. Aims: The aim of this is to evaluate the change in intraocular pressure (IOP) after laser suture lysis after trabeculectomy with mitomycin-C and to correlate the efficacy of suture lysis in relation to the time of lysis. Settings and Design: Prospective interventional study of seventy eyes of seventy patients. Subjects and Methods: Trabeculectomy with mitomycin-C was performed for 352 patients with glaucoma. Laser suture lysis was carried out when indicated for seventy patients during 2nd-8th week posttrabeculectomy. Primary outcome measures were IOP at immediate postsuture lysis, 1, 2, 4, 6, and 8 weeks, 3 and 6 months following laser suture lysis. For the purpose of statistical analysis, patients were divided into three groups depending on the week of suture lysis as <3 weeks, 3rd-5th week, and >5 weeks posttrabeculectomy and 21 mmHg was used as the cutoff for the achievement of target IOP. Statistical Analysis Used: Descriptive statistical analysis has been carried out. Significance is assessed at 5% level of significance. Student's t-test (two-tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups. Chi-square/Fisher exact test has been used to find the significance of study parameters on categorical scale between two or more groups. Results: On immediate postsuture lysis, 62 patients (88.6%) had IOP of <21 mmHg which increased to 68 patients (98.6%) at the end of 6 months postsuture lysis. When laser suture lysis was performed during 3rd-5th week posttrabeculectomy, 34 patients (73.9%) achieved the target IOP. Conclusions: Laser suture lysis during 3rd-5th week posttrabeculectomy with mitomycin-C is an effective and safe technique for reducing IOP. [ABSTRACT FROM AUTHOR]

Pur po se: To evaluate the effectiveness of laser suture lysis in patients with high intraocular pressure (IOP) after trabeculectomy. Ma te ri al and Met hod: We evaluated retrospectively 22 eyes of 22 patients who had undergone trabeculectomy followed by laser suture lysis due to high IOP between July 2009 and February 2011. The process was performed in patients who had high IOP with bleb formation after ocular massage in early postoperative period. Re sults: The mean age was 62.7±10.8 (38-77) years and the male/female ratio was 11/11 in the study group. The mean interval time between trabeculectomy and performance of suture lysis was 18.5 ±31.1 days (2-150 days). The mean IOPs before and immediately after laser suture lysis were 25 ±8.6 mmHg (14-45 mmHg) and 14±5.8 mmHg (6-27 mmHg), respectively (p

Background: The purpose of this study was to compare the outcomes of trabeculectomy using single sutures or releasable sutures. Methods: This retrospective study analyzed the medical records of 61 patients who had undergone trabeculectomy using single sutures (n = 33, 54.1%) or releasable sutures (n = 28, 45.9%). The scleral flap was secured with a mean 3.9 (range 3-5) single sutures in 33 patients and with three releasable sutures in 28 patients. Primary outcomes were the success rate, based on intraocular pressure and medication usage, and the frequency of complications and postsurgical interventions. The criteria used to determine complete success were, first, intraocular pressure < 18 mmHg and, second, ≤21 mmHg and ≥20% intraocular pressure reduction without glaucoma medication. Results: All patients had an intraocular pressure ≤ 21 mmHg; 87.5% in the single suture group and 92.6% in the releasable suture group had an intraocular pressure < 18 mmHg at 24 months. There was a highly significant reduction in intraocular pressure to baseline values in both groups at the last visit. Applying the first criterion, complete success was achieved in 57.6% of patients with single sutures and 71.4% with releasable sutures, and based on the second criterion, 66.7% and 71.4%, respectively. No significant difference was found between the groups with regard to intraocular pressure, or success or complication rates. Conclusion: The results of trabeculectomy using single sutures or releasable sutures are equivalent. Therefore, the choice of suture technique should be based on individual patient requirements and surgeon experience. [ABSTRACT FROM AUTHOR]

Purpose: To define a modified flap suture approach and evaluate its effectiveness., Methods: Clinical data of patients undergoing trabeculectomy with modified parallel suture technique ( Group 1, N = 38 eyes ) were compared to patients operated with classical flap suture technique ( Group 2, N = 42 eyes ). In the modified technique, two parallel sutures (one tight and one loose) are placed simultaneously in one of the flap corners with the aim of obtaining a safety stitch when the tight one needs to be cut. Data from preoperative and postoperative visits at day 1, week 1, months 1, 3, 6 and year 1 were recorded from patient charts and compared between the groups., Results: In Group 1 , seven eyes underwent laser suture lysis (LSL) between postoperative days 2 to 8 and in Group 2 two eyes at days 29 and 37. No complication related to LSL was observed. Rate of postoperative hypotony decreased with the parallel suture approach ( P = .002). Number of eyes experiencing any of the complications related to hypotony was lower in Group 1 ( P = .004). No significant difference was noted in the mean IOP between the groups ( P > .05 for all)., Conclusion: The modified approach with parallel suture technique was found to be effective and safe. By enabling early LSL, it provided more precise IOP modulation in the early postoperative period. Thus, in our series, the rate of hypotony and hypotony-related complications decreased, while the success of the surgery was preserved.

Background: To report our experience with laser suture lysis (LSL) following trabeculectomy with mitomycin C, its timing, effectiveness and related complications. Methods: We retrospectively examined 38consecutive eyes of 36 patients that underwent LSL following trabeculectomy with mitomycin C. Results: The mean preLSL intraocular pressure (IOP) was 27.0 mm Hg (SD 6.3, range 16–39 mm Hg) and the postLSL IOP (IOP 1 h after the last session of LSL)was 16.0 mm Hg (SD 7.2, range 3–31 mm Hg). Following the LSL in 7 eyes (7 of 38) hypotony (IOP<6 mm Hg, lasting more than 24 h) developed. Two groups were defined. In group I no hypotony was found after LSL and group II went through a period of hypotony. The time interval between surgery and LSL was significantly shorter in group II (mean 5.7, SD 7.5,range 1–19 days), compared to group I (mean 14.7, SD13.0, range 1–44 days) (p=0.041). The mean final IOP(IOP measured at the last visit) was 13.3 mm Hg (SD3.4, range 6–20 mm Hg) and mean follow-up was 6.1months (SD 3.9, range 2.0–15.2 months). No hypotony was found at final examination. PostLSL IOP and final IOP were significantly lower in group II (p=0.002 and p=0.024 respectively). IOP reduction by LSL was significantly greater in group II (p=0.046). Conclusion: LSL is an effective and safe procedure to lower the IOP following trabeculectomy with mitomycin C. Early application of LSL results in lower final IOPs, but has a higher risk of hypotony. [ABSTRACT FROM AUTHOR]

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Aim: To analyse the efficacy and safety of a standardized laser suture lysis protocol following trabeculectomy., Materials and Methods: Prospective interventional study conducted at a tertiary centre, between June 2016 and July 2017. Consecutive patients undergoing primary trabeculectomy with mitomycin C (0.4 mg/mL) for open angle glaucoma were enrolled. According to study protocol, a first laser suture lysis was performed routinely when intraocular pressure was greater than 10 mmHg, starting at postoperative day 8, and a second laser suture lysis was done whenever the intraocular pressure was newly greater than 10 mmHg, with a minimum interval of 1 week after the first laser suture lysis. Primary outcome was intraocular pressure (mean value, and mean difference from baseline in percentage). Safety parameters were also analysed., Results: Thirty-three eyes of 28 patients (13 males) were enrolled with a mean age of 69.6 ± 15.1 years. Pre-operative intraocular pressure was 24.9 ± 8.6 mmHg. All eyes underwent a laser suture lysis before the 12th postoperative week, with a mean intraocular pressure-lowering efficacy of 42.4% (p < 0.01). A second laser suture lysis procedure, when performed (n = 14), had an additional intraocular pressure-lowering efficacy of 26.7% (p = 0.02). Mean intraocular pressure at 1-month follow-up was 12.9 ± 8.2 mmHg, and during this period, two cases of self-limited choroidal detachments were noticed. Ten patients needed additional bleb needling. Mean intraocular pressure at 1-year follow-up was 13.8 ± 8.0 mmHg under an average of 0.4 topical intraocular pressure-lowering drugs (p < 0.01)., Conclusion: In our study, laser suture lysis was an effective tool to lower intraocular pressure during the early postoperative period, with an acceptable safety profile.