[Risks of 360 Degree Suture Trabeculotomy]

Background: In 1995, Beck and Lynch reported a method to perform a 360 degrees trabeculotomy by prolene suture introduced into Schlemm's canal. Because this type of surgery has proved to have perils and can lead to extreme hypotony, even a small series of cases must be reported.

Patients: Suture trabeculotomy was planned in five eyes of four patients, 5 and 7 months old and 6 and 51 years old, with primary congenital glaucoma, but completed in only two eyes.

Results: In one child, suture trabeculotomy could be accomplished easily in both eyes. In the first eye a 360 degrees-tomy was performed, in the second eye only a 180 degrees-tomy was done. Both eyes remained extremely hypotonic (4 mm Hg). In one eye Schlemm's canal could not be disrupted by the suture; in another eye, Schlemm's canal could be probed only for a short distance, and in one eye the suture went the wrong way.

Conclusions: Because a suture trabeculotomy can be transformed into a normal trabeculotomy any time, the main problems of the 360 degrees-suture trabeculotomy are not the possible technical difficulties, but that a successful suture trabeculotomy is followed by extreme hypotony.