A modified removable suture in trabeculectomy

We modified the closure of the scleral flap in trabeculectomy by using an externalized hemibow tie, easily removable in the early postoperative period. We used this externalized knot in 20 eyes of 17 patients undergoing trabeculectomy and in eight eyes of seven patients undergoing combined trabeculectomy and cataract extraction with intraocular lens implantation. The sutures were removed between 2 and 72 days after surgery (16.75 +/- 14.49 days). With a mean follow up of 11.36 months, the overall success rate was 78.6%. The sutures of nine eyes (32%) were removed due to elevated intraocular pressure and/or decreased bleb size. The immediate and long-term efficacies were 77% and 56%, respectively. The trabeculectomies we performed using this safe and simple technique, as compared with those using other methods of scleral flap closure, provided a lower incidence of postoperative complications due to overfiltration, and made it possible to increase the degree of filtration when needed during the early postoperative period.