Comparison Of The Intraoperative And Postoperative Effects Of 5-0 Prolene And 6-0 Prolene Suture Use In Gonioscopy-Assisted Transluminal Trabeculotomy

To compare the effects of 5-0 and 6-0 prolene suture use in Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) on intraoperative success, surgical complications and postoperative intraocular pressure(IOP).

This retrospective study was conducted at a tertiary ophthalmology center, analyzing data from patients who underwent GATT surgery performed by a single surgeon between January 2022 and October 2024.

Patients who had not undergone glaucoma surgery before, had a follow-up period of at least three months, had no history of uveitis or trauma, and had no anatomic variations in the angle were included in the study. A total of 32 eyes from 31 patients were included. There were 20 eyes in the 5-0 group and 12 in the 6-0 group.
 

Complete 360˚ trabeculotomy was achieved in 70% of the 5-0 group and 66.6% of the 6-0 group (p=0.68).  In cases where 360˚ trabeculotomy could not be completed in a single attempt, suture folding occurred in 3 cases and resistance during suture advancement in 1 case in the 6-0 group. In the 5-0 group, resistance during suture advancement was noted in 5 cases, and intraoperative hemorrhage causing surgical discontinuation occurred in 1 case. Hyphema, the most common complication, was observed in all patients, with macrohyphema lasting longer in the 5-0 group (5.5±1.6 vs. 4.2±1.3 days, p=0.017). Early postoperative transient IOP elevation(>26 mmHg) occurred in 35% of eyes in the 5-0 group and 16.7% in the 6-0 group(p=0.344).

6-0 suture is more flexible and advances easily through the schlemm canal but is less resistant to kinking. 5-0 suture is more rigid, more resistant to kinking, but may create more resistance during advancement. Both materials have distinct advantages and limitations. Suture selection should be guided by patient-specific factors, surgical instruments, and the surgeon's experience to achieve optimum results.