Transconjunctival flap sutures: A novel technique to combat hypotony

BACKGROUND: Hypotony secondary to overfiltration is a recognized complication following trabeculectomy. Persistent hypotony requires intervention . PURPOSE: We describe a modified version of placing conjunctival compression sutures directly over the scleral flap. SYNOPSIS: A 70-year-old male patient diagnosed with primary open angle glaucoma in both eyes underwent combined surgery in the right eye. On the tenth post-operative day, the patient presented with severe hypotony with 360° choroidal detachment. He was treated with corticosteroids and cycloplegics but developed hypotony maculopathy on the subsequent follow-up. Hence, he was further managed surgically by trans-conjunctival flap sutures to which he responded favorably with resolution of choroidal detachment and improvement in intraocular pressure and visual acuity. HIGHLIGHTS: Transconjunctival suturing of the scleral flap is an effective and minimally invasive treatment to prevent visual loss from hypotony maculopathy for an overfiltering bleb following trabeculectomy. ONLINE VIDEO LINK: https://youtu.be/BJtUZcyQZ-w