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PubMed1993

Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma.

BACKGROUND: The "true" prevalence and clinical attributes of exfoliation glaucoma remain controversial. The authors studied these characteristics in glaucoma patients requiring trabeculectomy. METHODS: One hundred consecutive patients undergoing trabeculectomy for open-angle glaucoma were investigated by clinical examination (biomicroscopy and gonioscopy) and classified into three categories: exfoliation glaucoma, possible exfoliation glaucoma, and primary open-angle glaucoma (POAG). A definitive diagnosis of exfoliation glaucoma was provided by pathologic examination of iris tissue. RESULTS: All 22 patients with clinical evidence of exfoliation glaucoma and 4 of 18 patients with possible exfoliation glaucoma on clinical examination had ultrastructural evidence of exfoliation material. The prevalence of exfoliation glaucoma, therefore, was 26%. The clinical examination for the diagnosis of exfoliation glaucoma had an 85% sensitivity rate and a 100% specificity rate. In comparison with POAG, patients with exfoliation glaucoma had higher untreated intraocular pressure (IOP), higher IOP with medical therapy, and shorter duration of medical therapy. They were more often operated on for unacceptably high IOP. Exfoliation glaucoma patients exhibited significantly lower IOP after surgery. CONCLUSION: Exfoliation glaucoma is common in patients requiring trabeculectomy for open-angle glaucoma. This condition differs from POAG by a poorer response to medical therapy and a better response to trabeculectomy.

Aged↗
PubMed1995

Outcomes of trabeculectomy for primary open-angle glaucoma.

PURPOSE: To determine the long-term functional and structural outcomes in patients treated with trabeculectomy for primary open-angle glaucoma. METHODS: Records of 78 consecutive patients (78 eyes) who had their first trabeculectomy were studied retrospectively (duration of follow-up, 25 to 112 months). Serial automated perimetry and stereoscopic optic disc photographs were used to assess the long-term efficacy of trabeculectomy to prevent progressive glaucomatous damage. Stereoscopic optic disc photographs were available for 29 eyes (38%). Criteria for intraocular pressure control were a minimum intraocular pressure reduction of 20% and intraocular pressure at or below 20 mmHg. RESULTS: There was no evidence of progression of glaucomatous damage in 81% and 65% of the eyes after 3 and 6 years, respectively. The visual field deteriorated in 16 eyes (21%) and progressive structural optic nerve damage occurred in 4 eyes (5%) during follow-up. Deterioration of the optic nerve head in the absence of visual field progression was detected in three (4%) of those eyes. In 19 eyes (25%), further glaucoma surgery was performed. The probability of successful intraocular pressure control after a single operation was 48% and 40% at 3 and 5 years, respectively. CONCLUSION: Progressive glaucomatous damage occurs in about one third of eyes with moderate to severe primary open-angle glaucoma over a 6-year follow-up after trabeculectomy.

Adult↗
PubMed1995

One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction.

PURPOSE: When patients with glaucoma require cataract surgery, combined procedures offer important advantages over cataract surgery alone. Because mitomycin C has improved the success rate of a trabeculectomy in patients at high risk for filtration failure, the authors investigated whether it also would increase the survival rate of functioning filters in combined procedures. METHODS: Patients with both cataract and glaucoma underwent combined mitomycin C trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation. Mitomycin C (0.5 mg/ml) was applied topically to the trabeculectomy site for 5 minutes before the cataract extraction. Intraocular pressure (IOP), visual acuity, and astigmatism were measured preoperatively and postoperatively. One-year results are available for 74 patients. RESULTS: At 1 year, 54 (73%) of 74 patients had IOPs of 15 mmHg or less without glaucoma medications. Visual acuity was 20/40 or better in 44 (60%) of 74 patients. Ten (15%) patients had a shift of more than 2 diopters of astigmatism against the rule compared with preoperative values. No notable corneal epithelial toxicity was present. Postoperative symptomatic hypotony with the wound construction occurred in 3 (4%) of 74 patients, with 1 patient requiring surgical revision. Other potential complications of mitomycin C include endothelial toxicity (1 patient had decreased vision due to endothelial folds) and wound stability (1 patient had wound rupture after direct ocular trauma). CONCLUSION: The 1-year survival rate of a functioning trabeculectomy using mitomycin C in combined glaucoma and cataract surgery is encouraging. The longer-term benefits and possible adverse effects of mitomycin C in combined procedures are unknown and continue to be investigated.

Adult↗
PubMed1996

Bleb-related endophthalmitis after trabeculectomy with mitomycin C.

PURPOSE: To determine whether filtering blebs resulting from adjunctive use of mitomycin C (MMC) leads to an increased risk of endophthalmitis. METHODS: The authors retrospectively reviewed the records of 232 consecutive trabeculectomies performed at the W. K. Kellogg Eye Center with adjunctive use of MMC from May 1990 through June 1993. Data obtained from the records included patient age, sex, race, type of glaucoma, site of filtration surgery, concentration and duration of exposure to MMC, presence of early or late bleb leakage, and the occurrence of endophthalmitis. RESULTS: Three patients were lost to follow-up less than 1 month after surgery. A total of 229 eyes of 192 patients (11 women and 82 men) were included in the study. Mean follow-up of patients remaining free of infection was 18.5 +/- 10.8 months (range, 1-44 months). The overall incidence of bleb-related endophthalmitis was 2.6%. Endophthalmitis developed in 8% of patients (4 or 50) in whom an inferior approach was used and in 1.1% (2 or 179) in whom a superior approach was used (P = 0.02, Fisher's exact test). The estimated odds ratio for the development of endophthalmitis after trabeculectomy with adjunctive MMC for inferior versus superior filtration sites was 7.7. CONCLUSION: Short-term follow-up of trabeculectomies performed with adjunctive use of MMC demonstrates an overall incidence of endophthalmitis comparable to filtrationprocedures performed with 5-fluorouracil or without antifibrotic agents. However, inferior trabeculectomy performed with adjunctive MMC carries a significantly increased risk of bleb-related endophthalmitis compared with filters performed superiorly.

Aged↗
PubMed1997

Bleb-related ocular infection in children after trabeculectomy with mitomycin C.

OBJECTIVE: The purpose of the study is to report the clinical course of bleb-related ocular infection in children after trabeculectomy with adjunctive mitomycin C. DESIGN: The study design was a retrospective review of all patients with a diagnosis of bleb-related ocular infection after trabeculectomy with adjunctive mitomycin C. PARTICIPANTS: Three children were identified in whom late postoperative bleb-related ocular infection developed. INTERVENTION: Treatment consisted of vitreous biopsy with intravitreous antibiotic and corticosteroid injection and/or bleb culture with topical and intravenous antibiotic administration. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were measured. RESULTS: Bleb-related ocular infection developed an average of 16.7 +/- 10.9 months after trabeculectomy (range, 4-23 months). The mean age at presentation was 7.0 +/- 2.6 years (range, 4-10 years). Vitreous cultures were positive for staphylococci in two cases. A bleb culture from the third case also grew staphylococcus. All of the children recovered their initial vision after treatment of infection. However, one lost six lines of vision after a subsequent retinal detachment. Additional glaucoma surgery was required in one patient. CONCLUSIONS: Late bleb-related ocular infection may occur in children after trabeculectomy with mitomycin C and is characterized by abrupt onset, bleb infiltration, and rapid progression. Despite early preservation of vision after treatment of infection, significant late visual loss can occur.

Anti-Bacterial Agents↗
PubMed1997

Mitomycin C-augmented trabeculectomy in refractory congenital glaucoma.

OBJECTIVE: The purpose of the study is to determine the safety and efficacy of mitomycin C-augmented trabeculectomy in children with developmental glaucoma treated previously by conventional procedures. DESIGN: Retrospective review of all cases of developmental glaucoma with previously failed conventional procedures that underwent mitomycin C-augmented trabeculectomy between January 1992 and December 1994. PARTICIPANTS: A total of 19 eyes of 13 patients were included in the study. Nineteen eyes included primary congenital glaucoma (15 eyes) with documented failure of primary trabeculotomy, Axenfeld-Reiger syndrome (2 eyes) and aniridia (2 eyes). INTERVENTION: Mitomycin C-augmented (0.4 mg/ml for 3 minutes) trabeculectomy was the chosen intervention. MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, time of surgical failure, and complications were the main outcome measures. RESULTS: The mean IOP was reduced from a preoperative level of 33.74 +/- 10.70 mmHg to 11.89 +/- 1.33 mmHg (P < 0.0001) with the percentage reduction in IOP being 64.75. The mean follow-up was 19.52 +/- 2.65 months. Visual acuity was maintained in all the cases after surgery. Complete success as defined in the authors' study was achieved in 18 eyes (94.74%). Only one patient was classified as a qualified success. The bleb was characterized by its large elevated, avascular, transparent appearance in all the eyes. The only significant complication was retinal detachment in an eye with buphthalmos, aphakia, and large axial length. However, the retina was reattached successfully by retinal reattachment surgery, and visual acuity improved to the preoperative level of 20/200. It was not possible to determine the cause of retinal detachment or to assess the possible role of mitomycin C in this complication. CONCLUSIONS: Mitomycin C-augmented trabeculectomy is a viable option in eyes with failed conventional trabeculotomy surgery.

Adolescent↗
PubMed1997

Effect of trabeculectomy on visual field performance in central 30 degrees field in progressive normal-tension glaucoma.

PURPOSE: The authors studied the effects of trabeculectomy on the time course of central 30 degrees visual field performances in progressive normal-tension glaucoma (NTG). METHODS: Patients with NTG who had clear ocular media and were adequate performers on the 30-2 program of Humphrey Perimeter were prospectively followed with periodic field testing. Trabeculectomy using an antimetabolite was indicated when the slope of a line fitted to the time course of the mean deviation (MD), MD slope, was significantly negative. The time courses of MD and mean of total deviations (mean TD) in four subfields, superior and inferior arcuate and superior and inferior cecocentral fields, were analyzed using the mixed linear model. RESULTS: In progressive NTG, 21 eyes of 21 cases with postoperative follow-up of 2 years or more, intraocular pressure averaged 16 mmHg, MD averaged -13.5 dB, and MD slope averaged -1.48 dB/year preoperatively; 2 years after surgery, they averaged 9.2 mmHg, -13.6 dB, and +0.13 dB/year, respectively. Trabeculectomy had a significant beneficial effect on the time course of MD and mean TD in the superior and inferior arcuate and superior cecocentral fields, which showed significant preoperative deterioration. The mean TD in the inferior cecocentral field showed no significant time change during the period studied. CONCLUSION: For patients with NTG in whom the MD slope is significantly negative, trabeculectomy may have beneficial and diffuse effects on further deterioration of the visual field.

Antimetabolites↗
PubMed1998

Trabeculectomy function after cataract extraction.

OBJECTIVE: To examine the effect of cataract extraction (CE) after trabeculectomy on intraocular pressure (IOP) control. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 115 consecutive patients who underwent extracapsular CE (N = 58) or phacoemulsification (N = 57) with intraocular lens (IOL) placement after trabeculectomy were studied. INTERVENTION: Cataract extraction with IOL after trabeculectomy was performed. MAIN OUTCOME MEASURES: Preoperative, intraoperative, and postoperative factors were evaluated for association with loss of IOP control requiring additional medications, bleb needling, or further glaucoma surgery, using Kaplan-Meier survival analysis and Cox multivariate proportional hazards survival regression. RESULTS: After mean postoperative follow-up of 21.1 +/- 14.3 months, additional glaucoma medication or needling of the filtering bleb to maintain IOP control was required in 35 eyes (30.4%) and was significantly associated with intraoperative iris manipulation and early postoperative peak IOP greater than 25 mmHg. Additional glaucoma surgery was eventually required in 11 eyes (9.6%) and was significantly associated with age of 50 years or younger, preoperative IOP greater than 10 mmHg, and early postoperative peak IOP greater than 25 mmHg. The cumulative proportion of patients who did not require reoperation for glaucoma was 93% and 90% at 1 and 2 years, respectively. The mean IOP at last visit had increased 1.6 mmHg above the pre-CE level and did not vary significantly after the first postoperative month. The median interval from CE to the addition of glaucoma medication or bleb needling was 1.6 months (within 3 months in 20 of 33 eyes) and that from nonsurgical intervention to further glaucoma surgery was 3.6 months (before the 7th postoperative month in 6 of 11 eyes). Of 19 eyes with hypotony (IOP < or = 6 mmHg) before CE, 11 eyes remained hypotonous after CE despite an increase in the mean IOP from 4.6 to 7.5 mmHg. CONCLUSIONS: When CE is performed after trabeculectomy, age of 50 years or younger, preoperative IOP greater than 10 mmHg, intraoperative iris manipulation, and early postoperative IOP greater than 25 mmHg are associated with worsened postoperative IOP control. Most bleb failures occur soon after CE. Resolution of pre-existing hypotony after CE is unpredictable.

Adolescent↗
PubMed1998

Surgical results of combined trabeculotomy-trabeculectomy for developmental glaucoma.

OBJECTIVE: The purpose of the study was to evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in different types of primary developmental glaucomas. DESIGN: A retrospective review of all cases of primary developmental glaucomas that underwent primary combined trabeculotomy-trabeculectomy between August 1990 and September 1995, with a minimum follow-up of 6 months, was performed. PARTICIPANTS: One hundred and eighty-two eyes of 120 patients were included in this study; 122 (67%) eyes had congenital glaucoma; 22 (12.1%) eyes had infantile glaucoma; and 38 (20.9%) eyes had juvenile glaucoma. INTERVENTION: Primary combined trabeculotomy-trabeculectomy was the chosen intervention. MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressures, visual acuities, success rate, corneal clarity and diameters, bleb characteristics, time of surgical failure, and complications were the main outcome measures. RESULTS: Intraocular pressure (mean +/- SD) reduced from a preoperative level of 26.5 +/- 8.3 mmHg; 30.3 +/- 9.9 mmHg; and 31.8 +/- 11.5 mmHg to 13.1 +/- 5.8 mmHg; 13.7 +/- 4.4 mmHg; and 13.3 +/- 6.0 mmHg in the congenital, infantile, and juvenile types of developmental glaucomas, respectively. Kaplan-Meier survival analysis showed that the success probability at 6 months was 94.4% +/- 2.3%; 90.9% +/- 6.1%; and 81.0% +/- 7.3% in the three groups, respectively. The success probability of patients with juvenile glaucoma was significantly lower than it was for those with congenital glaucoma (P = 0.0393). Of 182 eyes, 105 (57.7%) eyes had corneal edema at presentation. Eighty-one (79%) of 105 eyes had complete clearance of corneal edema postoperatively (P < 0.0001). The follow-up period ranged from 6 months to 48 months (mean, 10.7 +/- 12.0 months). There were no sight-threatening intraoperative and postoperative complications in any patient. CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in primary congenital glaucoma with corneal edema. Juvenile glaucoma has the worst prognosis, and infantile glaucoma has a better prognosis than does juvenile glaucoma.

Cornea↗
PubMed2000

Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas.

PURPOSE: To evaluate the effectiveness and safety of trabeculectomy with mitomycin-C (MMC) in the management of childhood glaucomas. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: All patients less than 18 years of age who underwent trabeculectomy with MMC from June 1991 through October 1997 were included. METHODS: The medical records of 29 consecutive patients (29 eyes) were reviewed. Data collected during routine patient follow-up were analyzed. Surgical outcome was evaluated using Kaplan-Meier life-table analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included intraocular pressure (IOP) control, visual acuity, and identification of complications. Successful IOP control was defined as 5 mmHg < or = final IOP < or = 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucomas. RESULTS: Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0.5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up time for patients categorized as successes was 25.1 +/- 16.0 months (range, 5.5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IOP control were 82%, 59%, and 59% respectively. There was no difference between the primary infantile glaucoma group and the secondary glaucoma group with respect to length of follow-up, rate of successful IOP control, and incidence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 months) after surgery. Other complications included hyphema, retinal detachment, late-onset bleb leak, flat anterior chamber, chronic hypotony, decompression retinopathy, suture abscess, and phthisis. CONCLUSIONS: Trabeculectomy with MMC may be useful in the management of childhood glaucomas in which goniotomy, trabeculotomy, or both have failed. However, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabeculectomy.

Adolescent↗
PubMed2000

Bleb reduction and bleb repair after trabeculectomy.

OBJECTIVE: To describe methods and outcomes for repair of bleb-related complications of trabeculectomy surgery. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: Thirty-one persons having bleb revision by two surgeons at the Wilmer Institute from 1994 to the present. INTERVENTION: One of two types of revision surgery was performed: bleb reduction to decrease symptoms from large blebs or bleb repair to improve hypotony, using conjunctival rotation flap or free conjunctival autograft. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure (IOP), reported symptoms, complications, and number of glaucoma medications at the final visit. RESULTS: The mean time from trabeculectomy to bleb revision was 4.4 years. Bleb reduction was performed because of symptomatic, high blebs in 11 eyes of 11 persons. Bleb repair was performed to end bleb leakage in 13 eyes of 13 persons and to increase IOP in 8 eyes of 7 persons with hypotony. Median visual acuity improved from 20/50 before revision to 20/30 at most recent follow-up. Mean IOP increased after treatment from 7.7+/-4.9 to 12.4+/-4.0 mmHg (P < 0.001). Symptoms that caused the revision surgery were eliminated in all cases. None of these eyes has lost IOP control, none has required repeat trabeculectomy, and only 2 of the 32 (6%) require topical glaucoma medication. More than one revision procedure was required in 8 of 32 (25%) eyes. CONCLUSIONS: Surgical bleb revisions for complications after trabeculectomy surgery are safe and effective. Bleb reduction for large, symptomatic blebs or bleb repair for leaking blebs and hypotony did not lead to loss of IOP control.

Adolescent↗
PubMed1999

Combined penetrating keratoplasty and trabeculectomy with mitomycin C.

OBJECTIVE: To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone combined penetrating keratoplasty and trabeculectomy with mitomycin C (MMC). DESIGN: Retrospective noncomparative case series. INTERVENTION: Penetrating keratoplasty combined with trabeculectomy with MMC and other surgical procedures. PARTICIPANTS: Twenty-four eyes of 22 patients undergoing combined penetrating keratoplasty and trabeculectomy with mitomycin C. MAIN OUTCOME MEASURES: Corneal graft clarity and intraocular pressure control. RESULTS: The cumulative probability of corneal graft survival was 85% at 1 year and 60% at 2 years. The cumulative probability of adequate pressure control was 67% at 3 months, 55% at 12 months, and 50% at 24 months. The incidence of bleb failure was higher in cases involving additional concomitant procedures, such as anterior vitrectomy, lens implantation or exchange, and drainage tube implantation. CONCLUSIONS: Combined penetrating keratoplasty and trabeculectomy with mitomycin C is associated with good corneal graft survival but also a risk of early failure of intraocular pressure control. Other concomitant procedures during the combined penetrating keratoplasty/trabeculectomy may increase the risk of early bleb failure.

Adult↗
PubMed1999

Primary combined trabeculotomy-trabeculectomy for early-onset glaucoma in Sturge-Weber syndrome.

OBJECTIVE: To evaluate the safety and efficacy of primary combined trabeculotomy-trabeculectomy in the management of early-onset glaucoma associated with Sturge-Weber syndrome (SWS). DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Ten eyes of nine patients were included in this study. All patients with SWS who underwent primary combined trabeculotomy-trabeculectomy from January 1993 through December 1996 were included. One patient had bilateral surgery. INTERVENTION: Primary combined trabeculotomy-trabeculectomy. MAIN OUTCOME MEASURES: Pre- and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, success rate, bleb characteristics, time of surgical failure (if any), and complications. RESULTS: The mean preoperative IOP was 28.2 mmHg +/- 7.35 mmHg with medication (mean, 1.2 +/- 0.6; range, 0-2). The mean postoperative IOP was 11.8 mmHg +/- 1.8 mmHg, with a mean percent reduction of 55.8 +/- 12.6 in IOP (P < 0.0001). All eyes maintained a postoperative IOP < 16 mmHg without medication over a mean follow-up of 27.6 +/- 16.4 months (range, 12-64 months). Normal corneal clarity was achieved in all eight eyes that had corneal edema. There were no significant intraoperative complications. Postoperatively, one patient developed a shallow anterior chamber with choroidal detachment, which was successfully managed conservatively. CONCLUSION: Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in early-onset glaucoma associated with SWS.

Child↗
PubMed2001

Short-term effect of mitomycin-C augmented trabeculectomy on axial length and corneal astigmatism.

PURPOSE: To evaluate the short-term effect of trabeculectomy with adjunctive mitomycin-C (MMC) on corneal astigmatism and axial length. SETTING: Asan Medical Center, University of Ulsan, Department of Ophthalmology, Seoul, Korea. METHODS: Eighteen consecutive eyes of 16 patients having trabeculectomy with adjunctive MMC were prospectively analyzed. Intraocular pressure (IOP) and axial length were evaluated preoperatively and 1, 3, 6, and 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis. RESULTS: The overall mean induced astigmatism showed with-the-rule change up to 3 months postoperatively followed by an against-the-rule shift. The mean axial length was significantly less postoperatively and changed throughout the 12 month follow-up. There was a positive correlation between postoperative axial length and IOP. Eyes with higher preoperative IOP had a greater decrease in axial length after trabeculectomy with MMC. CONCLUSION: The induced corneal astigmatism after trabeculectomy with MMC was long lasting, although less than that in previous studies. The change in axial length after surgery was significant, especially in eyes with a high preoperative IOP. The decrease in axial length persisted throughout the follow-up.

Adolescent↗
PubMed1996

Combined phacoemulsification, intraocular lens implantation, and trabeculectomy.

PURPOSE: To analyze the results of phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: John Moran Eye Center, University of Utah, Salt Lake City. METHODS: Two hundred twelve eyes of 174 patients with glaucoma and cataracts were analyzed retrospectively after cataract removal by phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. RESULTS: With an average follow-up of 26 months, patients had a significant improvement in visual acuity. The preoperative mean intraocular pressure (IOP) of 23.1 mm Hg decreased postoperatively to 15.9 mm Hg. Mean number of glaucoma medications decreased from 1.85 preoperatively to 0.41 postoperatively. Twenty-one patients (10% had a postoperative IOP of greater than 21 mm Hg, and seven required trabeculectomy revisions. CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy yielded excellent results in the treatment of patients with both cataract and glaucoma.

Adult↗
PubMed1999

Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation.

PURPOSE: To determine whether combined cataract surgery with endoscopic laser cycloablation produces less inflammation than cataract surgery combined with a filtering procedure. SETTING: Taylor Regional Hospital (surgeries) and EyeSight Associates (examinations), Warner Robins, Georgia, USA. METHODS: A randomized prospective study was conducted of 58 eyes of 58 patients comparing endoscopic laser cycloablation performed through a cataract incision at the time of cataract surgery with combined trabeculectomy and cataract surgery. RESULTS: Mean follow-up was 2 years. At the final available visit, 30% of endoscopic laser patients achieved intraocular pressure control (below 19 mm Hg) without medication and 65% with medication. Forty percent of trabeculectomy patients achieved control without medication and 52% with medication. Four endoscopic laser patients (14%) and 3 trabeculectomy patients (10%) were considered treatment failures (required additional surgical intervention). CONCLUSION: Endoscopic laser cycloablation performed through a cataract incision was a reasonably safe and effective alternative to combined cataract and trabeculectomy surgery, providing an option for cataract patients who have glaucoma requiring surgical intervention.

Cataract↗
PubMed1999

Late pigmented-membrane formation on silicone intraocular lenses after phacoemulsification with or without trabeculectomy.

PURPOSE: To determine the incidence of late inflammatory membrane formation with pigment precipitates on foldable silicone or poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) after phacoemulsification with or without simultaneous trabeculectomy and to identify probable causative factors. SETTING: Eye Department, Bnai-Zion Medical Center, and the Faculty of Medicine, the Technion, Haifa, Israel. METHODS: In this retrospective study, 155 eyes (140 patients) were divided into 4 groups by the surgery performed: Group 1, phacoemulsification combined with trabeculectomy and foldable silicone IOL implantation (12 eyes); Group 2, phacoemulsification combined with trabeculectomy and PMMA IOL implantation (15 eyes); Group 3, phacoemulsification alone with foldable silicone IOL implantation (66 eyes); Group 4, phacoemulsification alone with PMMA IOL implantation (62 eyes). Preoperative, intraoperative, and postoperative data were compared. RESULTS: Late inflammatory membranes were found on the anterior surface of 33% of the IOLs in Group 1, 3% in Group 3, and none in Groups 2 and 4. Membranes developed 3 to 4 months after surgery, were resistant to topical corticosteroid treatment and required repeated neodymium:YAG laser treatments. No correlation with preoperative, intraoperative, or postoperative factors was found. CONCLUSION: Foldable silicone IOLs may induce late postoperative inflammatory membranes with pigment precipitates, especially after combined phacoemulsification and trabeculectomy.

Aged↗
PubMed1999

Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma.

PURPOSE: To assess the efficacy and postoperative complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: Forty-four eyes of 44 patients with medically uncontrolled open-angle glaucoma had DSCI and a matched control group of 44 patients, trabeculectomy. A superficial scleral flap was raised and a deep sclerectomy performed in the scleral bed. Schlemm's canal was opened, and the cornea was dissected to Descemet's membrane. At that stage, aqueous filtered through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed; the scleral flap and conjunctiva were then closed. Examinations were performed before surgery and postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 15, 18, and 24 months. RESULTS: The mean follow-up was 14.4 months +/- 6.3 (SD) (range 3 to 24 months). The mean preoperative intraoperative pressure (IOP) was 26.7 +/- 7.3 mm Hg. The mean postoperative IOP was 6.1 +/- 4.5 mm Hg at 1 day and 11.0 +/- 4.4 mm Hg at 1 week; it remained stable for the next 24 months. The success rate, defined as an IOP lower than 21.0 mm Hg without medication, was 69% in the DSCI group and 57% in the trabeculectomy group at 24 months postoperatively (P = .047). The number of postoperative complications was significantly lower in the DSCI group than in the trabeculectomy group. CONCLUSIONS: The success rate of DSCI may be comparable to that of trabeculectomy, with fewer complications.

Aged↗