Comparative evaluation of bleb scores and central anterior chamber depth in trabeculectomy with conventional sutures versus releasable sutures

Purpose: Despite many advancements in the management of glaucoma, trabeculectomy remains the mainstay of surgical management. Since ocular hyoptony and shallow anterior chamber in the early postoperative period and their resulting complications are found to be the main cause for reduction in visual acuity following trabeculectomy, our study was designed to compare the IOP reduction and anterior chamber depth along with bleb scores in patients undergoing trabeculectomy with conventional interrupted sutures vs releasable sutures. Methods: The prospective randomized study was conducted in 40 eyes of 37 patients with the diagnosis of primary open angle glaucoma or primary angle closure glaucoma. The age of the patients in the study ranged from 40-69 years with a mean of 52.77+/-7.05 years. There were 14 males and 23 females in the study. A total of 40 eyes of 37 patients were randomly divided into 2 groups: Group A: 20 eyes undergoing trabeculectomy with conventional 10-0 nylon sutures and Group B: 20 eyes undergoing trabeculectomy with releasable 10-0 nylon sutures. All patients were kept on a regular follow up for a minimum period of3 months and postoperative assessment was done on day1, day 7, day 30 and day 90. Results: The mean IOP in the two groups was comparable at all postoperative visits (p>0.05). The mean percentage fall from preoperative IOP was comparable on follow up visits between the two groups. Bleb score was the lowest on first postoperative day in both the groups, progressively increasing over the period of follow up. There was no significant difference in the bleb score amongst the two groups in the initial postoperative period. Subsequently, by day 30, when the sutures had been released, Group B eyes had significantly better bleb scores than Group a (p=0.00). The mean central anterior chamber depth was lowest on the first postoperative day in both the groups, with significantly low CACD in group A(p=0.042). Subsequently, the mean CACD increased progressively in both the groups. Conclusion: Releasable suture technique is a simple and effective technique and should be considered as a safe and effective way to improve trabeculectomy outcomes.