Fornix-Based Trabeculectomy Conjunctival Closure: Winged Sutures versus Modified Wise Closure.

PURPOSE: To compare the midterm safety and efficacy profile of winged sutures versus modified Wise closure for fornix-based trabeculectomy.

DESIGN

Retrospective comparative study.

PARTICIPANTS

Consecutive cases that underwent fornix-based trabeculectomy by a single surgeon between January 5, 2015, and May 8, 2017.

METHODS

Potential cases were identified using the Current Procedural Terminology code, and their charts were reviewed thoroughly. Only 1 eye per patient was included. Demographic and clinical data were collected.

MAIN OUTCOME MEASURES: Primary outcomes were bleb leak and subsequent surgical revision rates. Secondary outcomes included intraocular pressure (IOP), number of glaucoma medications (NGM), visual acuity (VA), and other complications.

RESULTS

A total of 313 patients were identified, 157 with winged sutures and 156 with modified Wise closure. Baseline demographic and clinical characteristics were similar between the 2 groups. Twenty-six cases (16.6%) of winged sutures and 10 cases (6.4%) of modified Wise group developed bleb leak (P = 0.007), but only a total of 10 eyes needed bleb revision (P = 0.336). Other complications were similar in rates between the groups (P > 0.05). At 6 months, the modified Wise group had significantly greater IOP reduction (-3.10±1.29 [standard error], P = 0.016). Number of glaucoma medications reduction and VA evolution were similar between the 2 groups (P > 0.05).

CONCLUSIONS

Fornix-based trabeculectomy with either closure technique was effective in lowering IOP and NGM with comparable safety profile at 6 months. Furthermore, modified Wise closure provided larger IOP reduction and lower bleb leak rate, suggesting a potential superiority to winged sutures. Our study was limited by mitomycin C (MMC) delivery method change near the time of conjunctival closure change, although MMC delivery methods did not show significance in any outcome model.