Firm eye padding is frequently recommended as the initial management for moderate hypotony and shallow anterior chamber in the first few days post trabeculectomy. This might result from excessive filtration or a small leak.
Just wondering if there is any evidence out there in support of this, especially the bio mechanics of it. Putting pressure on a hypotonous eye might lead to some increase in the IOP, thereby forcing aqueous out and aggravating the shallow AC.
Would very much appreciate other views on this.
Firm padding done correctly helps to reform the AC but done wrongly flattens the eye. There is no Cochrane review on this and no clinical trials. Anecdotal evidence says it works when done correctly.
i prefer to do a bandage contact lens if the leak at the limbus and some cases i prefer to re suture and form AC
Thanks Abdul. I've not really found it to be useful, but, maybe we've not been applying it correctly! Thankfully shallow AC is not a frequent occurrence in my patients.
Both doctors's name is Mohamed, Please clarofy your agreement with who's opinion
Clinical experience shows that it works. As in the case of many older recommendations there is no evidence supported by controlled studies.
Although no evidence from case controlled study but pressure patching does work -my clinical experience , specially if shallow post-trabeculectomy anterior chamber with hypo tony is due to unintentional button hole during surgery in conjuctival bleb, So careful postoperative slit lamp examination is the key to success.This is the reason it is recommended. Presently i can give you the following link also:-
http://s160131.gridserver.com/wp-content/uploads/eye-surgery-in-hot-climates-06.pdf
We used to do firm eye padding for shallow AC following trabeculectomy and got AC formed after some days. It is possible firm eye padding encourages sealing and healing of areas of leakage leading AC formation. I think this is worthy of (further) research to understand the dynamics.
Eye padding dates back from early days when Trabeculectomy was done through limbal based conj.flaps. It certainly works well even in fornix based ops with conj. button holes or otherwise leaking wounds. Bandage CL became available later on and they work well if there is leakage at the limbus. Pressure applied helps to compress the leaking area and allows AC formation.