Parallel Suture: A Simple Approach to Enable Early Laser Suture Lysis and Prevent Hypotony after Trabeculectomy

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.