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Purpose : To report results of a novel “Conjunctival frill/ smile incision” on surgically induced astigmatism (SIA), patient discomfort and bleb morphology vs conventional trabeculectomy in initial postoperative period
Methods : Sixty trabeculectomy cases (30 in each group) were subjected to either conjunctival frill incision 1.5- 2.0 mm from limbus (Study group) or fornix based conjunctival flap (Control group). Corneal astigmatism & suture induced discomfort was assessed by keratometry & self-devised patient questionnaire respectively. Bleb evolution was studied over 6-months period by IBAGS & AS-OCT
Results : Both groups generated a “with the rule” SIA, which was 1.77 vs 2.42 at 1 week & reduced to 1.27 vs 1.8 in study vs control group; after removal of sutures. Further, SIA stabilizes between 1-3 months post trabeculectomy, thus any refractive correction by spectacles should be deferred till that time. Patient discomfort score, revealed enhanced comfort in 37% of study group while by 1 month good comfort was regained in all cases
Bleb morphology was similar regarding extent (E), vascularity (V) in both groups with moderate bleb height (H2) being more frequent in study group. Bleb maturation in control group resulted in slight flattening, documented by statistically significant decrease in bleb height (p<0.04), whereas for study group moderate bleb height was maintained at 6 months. Quantitative bleb assessment (AS-OCT) documented bleb wall thickness as 115-127 μ and 114-121 μ in study vs control, bleb height reduced from 242 to 230 μ in control group, with more number of microcysts in study group. Our study documented a positive correlation between bleb wall thickness, internal reflectivity, presence of microcysts and IOP control and a negative correlation between bleb height and IOP.
Conclusion : This novel suturing technique generates a functional healthy bleb with better wall thickness, increased internal reflectivity resulting in reduced SIA and patient discomfort
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