Literature DB >> 29582839

Comment on: Viscoelastic-augmented trabeculectomy - A newer concept.

Sanjay Kumar Daulat Thakur1.   

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Year:  2018        PMID: 29582839      PMCID: PMC5892080          DOI: 10.4103/ijo.IJO_865_17

Source DB:  PubMed          Journal:  Indian J Ophthalmol        ISSN: 0301-4738            Impact factor:   1.848


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Dear Sir, I read with keen interest the article entitled “Viscoelastic-augmented trabeculectomy: A newer concept” by Solanki et al.[1] Many ophthalmologists have tried this procedure since 1985[2] but most studies concluded that its use does not improve success rates. The authors have mentioned in the methods section that in the Group B: viscoelastic augmented trabeculectomy, “while injecting balanced salt solution (BSS) into the anterior chamber (AC), where the AC was filled with viscoelastic, movement of viscoelastic into the bleb space and subsequent elevation of the bleb were easily differentiated [Fig. 8].” But till that point in the surgery, neither the scleral flap nor the conjunctival flaps have been sutured. [Fig. 8] confirms the unsutured state. I would like to know from the authors that how did they see the elevation of the bleb in unsutured state and therefore unformed bleb. Further, the authors write “the bleb was well elevated by the underlying viscoelastic [Fig. 9].” Till this point also the scleral and conjunctival flaps have not been sutured as per the authors. However, [Fig. 9] shows a well-formed bleb. It seems to be a postoperative photograph rather than peroperative photograph. The authors then suture the scleral and conjunctival flap and give a subconjunctival injection. Ideally, the bleb would form subsequently. I appreciate the effort of authors in conducting this study, but the article is confusing in per operative section regarding bleb morphology. I think the authors need to suture the scleral and conjunctival flaps before injecting BSS in AC to appreciate the difference in the height of bleb. Otherwise the viscoelastic would just leak into the subconjunctival space. Interestingly, Jeong and Sung[3] have done the same procedure after suturing the scleral and conjunctival flaps.

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  3 in total

1.  Role of sodium hyaluronate (Healonid) in triangular flap trabeculectomy.

Authors:  S O Hung
Journal:  Br J Ophthalmol       Date:  1985-01       Impact factor: 4.638

2.  Augmentation of filtering blebs with viscoelastics in trabeculectomy.

Authors:  Hyerin Jeong; Kyung Rim Sung
Journal:  Korean J Ophthalmol       Date:  2014-09-18

3.  Viscoelastic-augmented trabeculectomy: A newer concept.

Authors:  Meghna Solanki; Ankur Kumar; Anubhav Upadhyay; Kishor Kumar
Journal:  Indian J Ophthalmol       Date:  2017-08       Impact factor: 1.848

  3 in total

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