LASER SUTURE LYSIS AFTER MITOMYCIN-C TRABECULECTOMY

Purpose: To evaluate the timing, efficacy, and complications of laser suture lysis (LSL) after mitomycin C trabeculectomy in patients with g laucoma at high risk for failure of filtering surgery. Methods: The au thors retrospectively reviewed the charts of 62 consecutive patients w ho underwent a total of 66 sessions of LSL after trabeculectomy with m itomycin C. Results: The interval from surgery to LSL ranged from 2 to 65 days (mean +/- standard deviation, 17.9 +/- 14.9 days). The averag e intraocular pressure (IOP) reduction after LSL was 11.9 +/- 8.9 mmHg (range, 3-40 mmHg), A longer interval to LSL was correlated with a le sser degree of pressure reduction (P = 0.0004, Wilcoxon rank-sum test) , After LSL, hypotony developed in 13 (21%) patients (IOP < 6 mmHg on 2 consecutive measurements at least 24 hours apart). This resolved spo ntaneously after 7 to 304 days (104.1 +/- 109.1 days) in 12 (92%) of t he 13 patients. Life-table success rates (success defined as 6 mmHg le ss than or equal to final IOP less than or equal to 21 mmHg) for the h ypotony and no hypotony groups were 100% and 86% (at 6 months) and 96% and 86% (at 12 months), respectively. The final visual acuity worsene d in a significantly greater percentage of patients in the hypotony gr oup (46%) compared with the no-hypotony group (18%) (P = 0.06, Fisher' s exact test). Conclusions: Laser suture lysis is safe and effective i n augmenting aqueous filtration after mitomycin C trabeculectomy. A lo nger time interval between surgery and LSL may result in both a lesser degree of IOP reduction and a lower incidence of subsequent hypotony.