|LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 4 | Page : 604
Comment on: Viscoelastic-augmented trabeculectomy – A newer concept
Sanjay Kumar Daulat Thakur
Department of Ophthalmology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
|Date of Web Publication||26-Mar-2018|
Prof. Sanjay Kumar Daulat Thakur
Flat 1C, Rohini Apartment, 8/1A Canal Street, Behind Entally PS, Kolkata - 700 014, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thakur SD. Comment on: Viscoelastic-augmented trabeculectomy – A newer concept. Indian J Ophthalmol 2018;66:604
I read with keen interest the article entitled “Viscoelastic-augmented trabeculectomy: A newer concept” by Solanki et al. Many ophthalmologists have tried this procedure since 1985 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 [Figure 8].” But till that point in the surgery, neither the scleral flap nor the conjunctival flaps have been sutured. [Figure 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 [Figure 9].” Till this point also the scleral and conjunctival flaps have not been sutured as per the authors. However, [Figure 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  have done the same procedure after suturing the scleral and conjunctival flaps.
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| References|| |
Solanki M, Kumar A, Upadhyay A, Kumar K. Viscoelastic-augmented trabeculectomy: A newer concept. Indian J Ophthalmol 2017;65:705-711.
] [Full text]
Hung SO. Role of sodium hyaluronate (Healonid) in triangular flap trabeculectomy. Br J Ophthalmol 1985;69:46-50.
Jeong H, Sung KR. Augmentation of filtering blebs with viscoelastics in trabeculectomy. Korean J Ophthalmol 2014;28:393-8.