Late removal of releasable sutures after trabeculectomy and combined surgery with anti-metabolites

Purpose. Releasable scleral-flap sutures have been effectively used in trabeculectomy and the suggested time for the effective suture removal is in the first two post-operative weeks. We wished to determine whether the use of intra-operative anti-metabolite alters the time of suture removal and the results of the surgeries. Methods. The charts of 350 patients (412 eyes) undergoing trabeculectomy and 150 patients (183 eyes) undergoing combined trabeculectomy with cataract extraction were retrospectively reviewed. Intraoperative MMC was used in 558 eyes and 5-FU in 37 eyes. Results. 95 patients (103 eyes) with trabeculectomy and 61 patients (65 eyes) with combined surgery had releasable suture removal more than 21 days post-operatively. The suture removal was deferred in 49 eyes because of early post-operative hypotony (IOP<5mmHg) and/or shallow anterior chamber. There was no complication or hypotony in the other 119 eyes but suture removal was delayed when IOP<10mmHg. In eyes with two releasable sutures, the time of second suture removal ranged in 21-524. days post-operatively, and 21-97, days post-operatively in cases with trabeculectomy and combined surgery, respectively. The range of the intraocular pressure reduction was 3-41 mmHg. after the first suture removal and was 2-7mmHg. after the second suture removal. No serious complication associated with late suture removal was noted during the follow-up period (15.8+12 months). Conclusions. Adjunctive intra-operative anti-metabolite therapy delays wound healing and may extend the period that releasable suture removal is clinically effective.