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  • Title: The influence of scleral flap position and dimensions on intraocular pressure control in experimental trabeculectomy.
    Author: Birchall W, Wakely L, Wells AP.
    Journal: J Glaucoma; 2006 Aug; 15(4):286-90. PubMed ID: 16865004.
    Abstract:
    PURPOSE: To assess the effect on intraocular pressure (IOP) of varying the length of the side incisions of the scleral flap during trabeculectomy. MATERIALS AND METHODS: Trabeculectomy operations were performed with adjustable sutures on 8 donor human eyes connected to a constant flow infusion with real-time IOP monitoring, using either a large (4 x 4 mm, 16 mm, n=8) or a small (3 x 2 mm, 6 mm, n=8) scleral flap. For each flap the side incisions began 1 mm behind the limbus and extended to the posterior edge of the flap. The side incisions were extended sequentially in 0.5-mm steps up to the limbus, then each flap dissected 1 mm further into clear cornea. RESULTS: Mean IOP after sclerostomy fashioning was 0.84 mm Hg (range 0 to 2.7 mm Hg). After flap closure, with side incisions extending to 1 mm behind the limbus, mean IOP was 21.6 mm Hg (79.5% of baseline) and 23.03 mm Hg (79.2% of baseline) for large and small flaps (P=0.26). In each size group, extending flap side incisions to the limbus produced a small nonsignificant fall in mean IOP, whereas flap extension 1 mm into clear cornea led to a significantly lower mean IOP relative to baseline of 43.2% (P<0.05) for large flaps and 35.4% for small flaps (P<0.01). CONCLUSIONS: Using this adjustable suture technique, IOP is well maintained for both flap sizes if the flap and side incisions do not extend beyond the limbus. Excessive forward dissection of a scleral flap into the clear cornea, anterior to the sclerostomy may result in increased aqueous outflow and lower IOP.
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