Transconjunctival suturing technique is easy and fast¹ and can be used to treat hypotonia at any time in the postoperative period, both early and late². The only essential condition is that the conjunctiva has good resistance. It is not advisable to use this technique when the conjunctiva is thin or ischemic, because it may cause an aqueous humor leakage at the sites where sutures pass. Transconjunctival suturing are very little traumatic for the conjunctiva and induce little inflammatory reaction, which helps preserve fistula function³. Additionally, they are easily removable, allowing to regulate intraocular pressure in the postoperative period⁴. The technique was started with some radial sutures followed by conjunctiva and sclera transfixion, passing through the posterior edge of the scleral flap. It is important to pass the needle deeply, to include the sclera plane. Next, X-sutures over the scleral flap were made, to compress the flap and restrict the flow. It is possible to make several sutures in X, but usually 1 or 2 sutures are enough, so that the surgery ends with the eye in good tension. Over time, long sutures tend to loosen5 and usually need to be removed after 1 or 2 years.

REFERENCES

1. Maheshwari D, Shyam P, Pawar N, Ramakrishnan R. Transconjunctival flap sutures: A novel technique to combat hypotony. Indian J Ophthalmol. 2022;70(3):1073.

2. Letartre L, Basheikh A, Anctil JL, Des Marchais B, Goyette A, Kasner OP, et al. Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy. Can J Ophthalmol. 2009;44(5):567-70.

3. Eha J, Hoffmann EM, Pfeiffer N. Long-term results after transconjunctival resuturing of the scleral flap in hypotony following trabeculectomy. Am J Ophthalmol. 2013;155(5):864-9.

4. Maruyama K, Shirato S. Efficacy and safety of transconjunctival scleral flap resuturing for hypotony after glaucoma filtering surgery. Graefes Arch Clin Exp Ophthalmol. 2008;246(12):1751-6.

5. Yu JT, Mercieca K, Au L. Conjunctival bleb compression sutures: An effective method of addressing hypotony after trabeculectomy or trabeculectomy-related procedures. Eur J Ophthalmol. 2018; 28(6):731-4.

AUTHOR INFORMATION

»Heloisa Maestrini
http://lattes.cnpq.br/3127610014293687
https://orcid.org/0000-0001-5189-783X

Received on: November 30, 2022.
Accepted on: December 18, 2022.