Abstract
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Background: Trabeculectomy remains an effective surgical treatment for glaucoma. However, achieving adequate aqueous filtration while preventing early postoperative hypotony remains challenging. Releasable scleral flap sutures allow postoperative adjustment of aqueous outflow and may improve early intraocular pressure (IOP) management.
Methods: A narrative review of published clinical studies and surgical techniques involving releasable sutures in trabeculectomy was conducted. The Kolker and Johnstone techniques, clinical indications, postoperative suture management, complications, and comparisons with laser suture lysis were examined, emphasizing practical applications in resource-limited settings.
Results: Releasable sutures provide adjustable postoperative filtration without requiring specialized laser equipment. A randomized pilot study involving 30 patients reported lower rates of early hypotony with releasable sutures than with conventional sutures (20% vs. 53%). A larger randomized trial involving 175 patients also demonstrated reduced transient hypotony (9.1% vs. 20.4%), although no significant overall surgical advantage was established. Another comparative study reported similar six-month success rates between releasable sutures and laser suture lysis (90% vs. 92%). Suture removal should be individualized according to IOP, bleb morphology, anterior chamber depth, and hypotony risk.
Conclusion: Releasable sutures offer a simple, inexpensive, and practical approach to postoperative IOP adjustment following trabeculectomy. They may reduce early hypotony, although evidence for superior long-term outcomes remains inconclusive. Their accessibility makes them particularly relevant to glaucoma surgery in resource-limited settings.
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