[Regulating intraoperative pressure in filtering glaucoma operations with a sterilizable tonometer]

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Complications

Context:

• Filtering procedures for glaucoma, such as trabeculectomy, can lead to short-term complications like hypotony (low intraocular pressure) or hypertony (high intraocular pressure).
• These complications arise from difficulties in adjusting scleral flap tension to achieve therapeutic intraocular pressure (IOP) ranges.
• An improved filling test aims to mitigate these issues by enhancing intraoperative control.

Purpose:

• To present a novel filling test for trabeculectomy to improve intraoperative adjustment of scleral flap tension.
• To reduce the incidence of hypotony and hypertony following glaucoma filtering surgery.
• To establish a reliable method for intraoperative pressure measurement and adjustment.

Summary:

• Trabeculectomy was performed on 22 eyes using a new filling test and applanation tonometer to adjust scleral flap opening pressure between 5 and 20 mm Hg.
• Postoperative IOP correlated well with intraoperative flap opening pressure (r=0.771), with an average 20% decrease.
• All patients achieved sufficient filtration and IOP below 20 mm Hg; deep chambers were noted initially, with temporary shallowing in 4 eyes experiencing lower intraoperative pressures (5-10 mm Hg).

Impact:

• Intraoperative pressure control during trabeculectomy provides a reliable estimation of postoperative IOP.
• Selecting an intraoperative pressure of 15-20 mm Hg can effectively prevent hypotony and shallow anterior chambers.
• This technique offers a method to avoid both hypotony and hypertony, improving surgical outcomes in glaucoma management.