NOVEL INVERTED SCLERAL FLAP VALVE: A NEW SURGICAL APPROACH TO MINIMIZE TRABECULECTOMY COMPLICATIONS AND PRESERVE CORNEAL HEALTH - A COHORT STUDY

Dr. Seyed Mostafa Reza Borsi*, Dr. Taym Darwish, Dr. Mahmoud Ahmed Ragab and Dr. Afraa Salman

ABSTRACT

Trabeculectomy is a common procedure for lowering intraocular pressure in glaucoma patients. However, it can negatively impact the integrity of corneal endothelial cells and central corneal thickness (CCT), potentially leading to vision-threatening complications. This cohort study aimed to evaluate the effectiveness and safety of a novel surgical technique that minimizes these complications by creating an autovalve from an inverted scleral flap during trabeculectomy. The study focused on assessing the impact on the cornea and comparing it to conventional methods. The study included 50 glaucoma patients (20 males and 30 females) who underwent trabeculectomy, divided into three groups: Group 1 (20 males, mean age 66.15 years), Group 2 (30 females, mean age 59.3 years), and a control group (30 patients who underwent conventional trabeculectomy with similar age and gender distribution). Preliminary results showed a significant reduction in the incidence of trabeculectomy complications in the groups utilizing the innovative valve technique compared to the control group, including:
 Hypotony
 Leakage
 Infection
 Inflammation
 Bleb size
Chi-square analysis revealed statistically significant differences in the incidence of all complications among the groups (P < 0.05). Additionally, there was no need for scleral sutures or mitomycin C in the groups utilizing the valve technique, unlike the control group. The study also demonstrated that the novel valve technique helped preserve the integrity of corneal endothelial cells and central corneal thickness. Before surgery, there was no statistically significant difference in corneal endothelial cell count between males and females (P = 1). After surgery, no significant decrease in corneal endothelial cell count was observed in the groups utilizing the valve technique (P = 0.23 for Group 1 and P = 0.37 for Group 2), compared to a significant decrease in the control group (P = 0.02). The results also showed a statistically significant difference in central corneal thickness before surgery between patients under 70 years old and those above 70 (P < 0.0001). After surgery, a slight, non-significant decrease in central corneal thickness was observed in the groups utilizing the valve technique (P = 0.11 for Group 1 and P = 0.08 for Group 2), while a significant decrease was observed in the control group (P = 0.03). These promising findings indicate that the novel inverted scleral flap valve technique is a promising new surgical approach for treating glaucoma while preserving corneal health.

Keywords: Glaucoma, Trabeculectomy, Autovalve, Inverted Scleral Flap, Surgical Complications, Cohort Study, Corneal Endothelial Cells, Central Corneal Thickness.