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Releasable Flap Sutures

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Title:  Releasable Flap Sutures
Author:  Cole Joseph Swiston; Craig Chaya
Date:  07/11/2024

4-throw Releasable Trabeculectomy Flap Sutures

Initially described by Cohen and Osher the releasable flap suture allows for easy and quick “suture lysis” without the need for an argon laser or Hoskins lens. The following sutures are shown in a trabeculectomy with a fornix-based flap and a small skirt of conjunctiva which is closed using the Condon technique. These sutures are 10-0 nylon on a CS needle and are pre-placed prior to entering the eye and creating the sclerostomy.

  1. Partial thickness pass in peripheral clear cornea which serves to bury the suture and hold it in place until released.
    • Be careful not to interact with your vicryl traction suture and be mindful of where you place the traction stitch at the beginning of the case.
  2. Partial thickness pass from clear cornea under the conjunctival skirt and emerge over the flap.
    • Aim for this to be deep enough to not interact with the eventual conjunctival closure suture which will be in superficial episclera.
    • Ensure this pass is parallel to and over the flap. If it is not, your flap compression may be compromised, and flow may be too brisk.
  3. Full thickness pass through the flap about 1/3 from the posterior edge of the flap followed by a partial thickness scleral pass.
    • We like to place this suture more tangential to the side of the flap rather than a radial pass at the corner to ensure good side compression and to promote posterior flow.
  4. Keratome entry followed by scleral punch.
  5. Suture is tied with 4 throws to a small loop over the flap.
    • Can be tightened by pulling the scleral tail end and the loop.
    • The loop can be shortened by pulling the corneal tail end.
  6. Burp viscoelastic from the anterior chamber and evaluate flow. Tighten as needed.
  7. Trim the scleral tail end.
  8. Close conjunctiva.
  9. Trim the corneal tail end.

In clinic, the suture can be snared with a Jewelers’ forceps or 30 gauge needle and then pulled with forceps to release.

Faculty Reviewer: Susan Chortkoff, MD
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