Outcomes of conjunctival compression sutures for hypotony after glaucoma filtering surgery.

OBJECTIVE To evaluate the outcomes of conjunctival compression sutures (CCS) for enlarged overfiltering blebs associated with ocular hypotony after uncomplicated trabeculectomy with mitomycin C (TM). METHODS A retrospective analysis of consecutively recruited patients with enlarged conjunctival bleb associated with hypotony who had undergone CCS was performed. Patients were considered for CCS if they had enlarged overfiltering bleb for at least 4 weeks, following an uncomplicated TM, with no sign of resolution. Only patients with hypotony, defined as intraocular pressure (IOP) <6 mm Hg associated with a reduced vision of at least 2 lines, were included. Success was defined as an IOP 
>6 mm Hg 6 months after surgery. RESULTS A total of 45 eligible patients were identified. In 29 eyes of 45 patients (64.4%), success in providing resolution of the preexisting hypotony (postoperative IOP mean ± standard deviation 13.4 ± 1.8 mm Hg, range 10-16 mm Hg) was obtained. Out of these 29 eyes, 9 eyes had a conjunctival bleb diffusion over 180 degrees, 19 eyes overfiltering bleb over 270 degrees, and 1 eye over 360 degrees. Complications from CCS included a transient spike of IOP in the first postoperative week (8 patients); a bleb rupture associated with conjunctival leaks and hypotony was observed in one eye. CONCLUSIONS The placement of CCS is a safe and effective technique for managing overfiltering blebs associated with hypotony. The present study suggests that CCS are not effective for dealing with circumferential blebs extending over 360 degrees.