Uso da sutura compressiva em complicações e intercorrências da cirurgia antiglaucomatosa
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Data
2014-12-01
Autores
Agostini, Fernanda Spinassé
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Universidade Federal do Espírito Santo
Resumo
Objective: To present a comprehensive account of the use of compression sutures in complications and intercurrence of antiglaucomatous surgery. Material and Methods: Descriptive study. Using the medical records of patients who underwent compression sutures from 1999-2012, we analysed the methods used for complications and intercurrence of antiglaucomatous surgery. For post-operative complications: in Seidel, case results were evaluated based on immediate and long-term occlusion and changes in filtering blebs; hyperfiltering blebs: immediate and long-term outcomes in intraocular pressure and changes in filtering bleb; symptomatic filtering bleb: improvement in symptoms and the modification of the architecture and function of the bleb; For intraoperative complications: effectiveness at preventing external leakage through the conjunctival flap and undesirable filtering or hyperfiltering of the scleral flap. Results: A total of 41 cases of post-operative complications, 39 of Seidel and hyperfiltering bleb, and two symptomatic blebs were studied. For the 14 early Seidel cases, resolution was obtained immediately and in long-term in 92.8% of the cases. Bleb formation occurred in seven cases, maintenance of the bleb in four cases, and failure in three cases. In nine late Seidel cases there was immediate resolution in 85.7% of the cases and long-term resolution in 57% of the cases. Bleb failure occurred in two cases in which the Seidel had been occluded. In 14 hyperfiltering bleb cases in the early postoperative period there was immediate resolution of hypotony in 85.7% of cases and long term resolution in 78.5%, with maintenance of the bleb in 13 of these. In both hyperfiltering bleb cases in the late postoperative period, there was immediate and long-term resolution of hypotonia. For the two cases of symptomatic blebs there was resolution of symptoms and improvement in appearance with maintenance of filtering bleb function. Objectives were achieved intraoperatively for surgical complications in all 42 cases of external leakage of the conjunctival flap, two cases in which avoidance of excessive bleb extension was the aim, and in cases of excessive or unwanted filtration through the scleral flap. Conclusion: Isolated compression sutures represent an alternative for the treatment or prophylaxis of surgical complications in glaucoma surgery, and can be used as a complement to conventional sutures. Compression sutures are also useful to treat and to prevent symptomatic blebs. However, the results obtained for late Seidel in microcystic blebs and in hyperfiltering blebs in general do not encourage us to position them among the best options.
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Glaucoma , Procedimentos cirúrgicos oftalmológicos , Hipotensão ocular