Laser Suture Lysis and Releasable Sutures

Since first being described by Cairns in 1968, trabeculectomy, with guarded filtration, was for decades the preferred surgical method of reducing intraocular pressure (Cairns, Am J Ophthalmol 66:673–679, 1968). The goal of trabeculectomy is to create a balance between aqueous humor inside the eye and the filtering conjunctival bleb. To establish this balance, a scleral flap must be created that is loose enough to allow outflow but tight enough to prevent postoperative hypotony (Savage et al., Ophthalmology 95:1631–1637, 1988; Lieberman, Am J Ophthalmol 95:257–258, 1983). A number of adverse events may occur with overfiltration from loose sutures, including shallow chambers, choroidals, suprachoroidal hemorrhages, maculopathy, and progressive cataract formation (Savage et al., Ophthalmology 95:1631–1637, 1988; Lieberman, Am J Ophthalmol 95:257–258, 1983; Pappa et al., Ophthalmology 100:1268–1274, 1993; Macken et al., Br J Ophthalmol 80:398–401, 1996; Jampel et al., Arch Ophthalmol 110:1049–1050, 1992; Schwartz and Weiss, Arch Ophthalmol 110:1049, 1992; DiSclafani et al., Am J Opthalmol 108:597–598, 1989). Tight closure of the flap can avoid these complications but at the peril of achieving the desired intraocular pressure. To manage these dueling forces, laser suture lysis and the use of releasable suture are commonly employed.