Trabeculectomy With Sclera Flap Interlayer Imbed Suture For The Treatment Of Refractory Glaucoma

Objective: To evaluate the effect of the modified Trabeculectomy which sclera flapinterlayer imbed suture for treatment of refractory glaucoma.Methods: We modified the traditional Trabeculectomy as follows:1)increased the scleral flap area from 4mm×4mm to 6mm×6mm.2)increased the scleral flap sutures from 2 to 5.3)We changed the suture procedure from the original contraposition suture of thesclera flap superior angel to a wide span imbedding suture along the five directions oftrabecula cutting edge and connect the stitch to the cutting by intervolving the toe-into the sclera flap.After suturing the scleral flap with modified method, there can be a "space" underthe flap,the occlusion of the filtering tunnel can be prevented in a way. Also the widespan imbedding suture forming a certain tension leads to controlling the aqueousout-flowing and promoting the early development of the anterior chamber.64 patients (64 eyes) with refractory glaucoma were chosen from the treated atthe Department of Ophthalmology Center, Tian Jin Medical University and DaGangHospital Tian Jin between 2001 and 2006. 33cases (33 eyes) was treated withmodified treament and 31 cases (31 eyes) was treated with conventional treatment.The effect of treatment and complication was compared and evaluated. The ayeragefollow-up period was 6 to 12 months postoperatively.Results: (1) No significantly differences in visual acuity were found between two groups.(2)The postoperative intraocular pressures (IOP) were significantly lower thanthe the preoperative IOPs in both groups, while the IOPs on the 7th day after surgerybetween the two group were not different significantly. The average postoperativeIOP at the 6th month in the modified treament group was 15.08±4.17mmHg and18.79±5.56mmHg in the conventional treatment group, which were differentsignificantly (P＜0.05). The successful rates were 84.8% and 67.7% in two groupsrespectively.(3)The percentage of functional fiin the modified treament group was 81.8%, significantly higher than that of 58.1% in the conventional treatmentgroup (P＜0.05).(4)The incidence rate of shallow anterior chamber in the modified treamentgroup was lower than that in the conventional treatment group, The two groups weredifferent significantly (P＜0.05). but all the cases had recovered by the end of 1week after proper treatment.Conclusion: The short-term effect of modified method was more effctive thanconventional method, which is not only more safe and easy, but also can preventfiltering canal from blocking and reduce the complication. The long-term effect shoudbe observed further.