Comparison of Superior Rectus and Peripheral Lamellar Corneal Traction Suture during Trabeculectomy

To compare the efficacy and safety of two different traction suture (superior rectus traction suture and peripheral lamellar corneal traction suture) in patients undergoing trabeculectomy.

This retrospective trial compared outcomes of 385 eyes that underwent trabeculectomy with superior rectus traction suture (SRTS group; 206 eyes; 53.3%) and peripheral lamellar corneal traction suture (CTS group; 179 eyes; 46.7%). Qualified surgical success is defined as an intraocular pressure (IOP) between 6 and 21 mm Hg with or without topical anti-glaucoma medication.

After a follow-up of 24 months, the difference of IOP was significant (p = 0.042). The mean number of anti-glaucoma medications was 3.5 ± 0.6 and 3.5 ± 0.5 preoperatively (p = 1.000), whereas 0.18 ± 0.32 and 0.10 ± 0.39 at 24 months (p = 0.028). The 24-month qualified surgical success rates were 88.3% and 94.4% for both groups (p = 0.035; log-rank test). The difference between the two groups in regard to maximal bleb area is statistically significant (p = 0.011), with CTS group exhibiting more diffuse bleb area. The difference between the two groups in regard to the vascularity at the central and peripheral part of bleb is statistically significant (p = 0.019; p = 0.023, respectively). Encysted blebs was seen in 27 (13.1%) eyes in SRTS group and in 12 (6.7%) eyes in CTS group (p = 0.041).

The use of superior rectus traction suture is significantly associated with a lower success rate than corneal traction suture, suggesting that surgeons should use a corneal fixation suture if at all possible.