Adjustable sutures may reduce incidence of shallow anterior chamber, hypotony

The authors conducted this prospective, randomized study to compare the IOP-lowering effect of adjustable sutures and laser suture lysis in eyes with primary open-angle glaucoma undergoing trabeculectomy. While they found  no significant difference in IOP lowering efficacy between the groups, they did observe a reduction in the incidence of shallow anterior chamber and hypotony with adjustable sutures.  

They randomized 50 Japanese patients (50 eyes) with primary open-angle glaucoma to undergo either trabeculectomy augmented with mitomycin C with adjustable sutures or with laser suture lysis. Mean baseline IOP was not significantly different between the groups (27.8±2.8 mmHg in the adjustable suture group vs. 27.3±2.9 mmHg in the laser suture lysis group; P=0.7).

There was no significant difference in mean IOP between the groups at any time point, although IOP reduction was greater in the adjustable suture group at every visit. At 12 months, a similar percentage of patients in each of the groups, 96 percent in the adjustable suture group and 92 percent in the laser suture lysis group, were considered to be a success (P = 0.5).  However, 24 percent of patients in the laser suture lysis group experienced significant anterior chamber reduction after loosening of the adjustable sutures or laser suture lysis. No patient in the adjustable suture group experienced anterior chamber reduction.

The authors conclude that adjustable sutures may reduce the incidence of shallow anterior chamber and hypotony after postoperative IOP lowering procedures; however, future study of a large population is needed to verify these observations. Nonetheless, they note that this information may be clinically valuable when treating patients with primary open angle glaucoma and coexisting cataracts.