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PubMed2000

Changes in the nerve fiber layer thickness following a reduction of intraocular pressure after trabeculectomy.

PURPOSE: To assess changes in the nerve fiber layer thickness after trabeculectomy using scanning laser polarimetry. METHODS: The authors prospectively enrolled 46 eyes from 46 patients with primary open-angle glaucoma in whom intraocular pressure had been reduced by more than 30% after trabeculectomy without significant ophthalmic complications and from whom good quality images were obtained by a scanning laser polarimetry preoperatively and at 3 to 6 months after trabeculectomy. In each enrolled eye, changes in the nerve fiber layer thickness after surgery in the defined ring (1.8 disc diameters) around the optic disc were calculated in 10 degrees intervals (36 sectors in total) and in the following 4 quadrants (the sum of 9 10 degrees sectors): superior, nasal, inferior, and temporal. RESULTS: The mean intraocular pressure was 22.6 +/- 6.9 mm Hg preoperatively and 10.2 +/- 3.7 mm Hg postoperatively (P < 0.01). According to the analyses in every 10 degrees, the postoperative nerve fiber layer thickness was significantly greater than the preoperative nerve fiber layer thickness in the superotemporal region (10-50 degrees) and inferotemporal region (290-340 degrees) of the optic disc (P < 0.05). A stepwise multiple regression analysis showed that only the preoperative mean deviation in the Humphrey visual fields was a significant independent factor associated with changes in the nerve fiber layer thickness in the nasal and inferior quadrants. CONCLUSIONS: The thickness of the nerve fiber layer, as measured by scanning laser polarimetry, may increase after trabeculectomy, especially in the superotemporal and inferotemporal regions, and can be expected in cases in the early stage of glaucoma that have a better mean deviation.

Diagnostic Techniques, Ophthalmological↗
PubMed2002

Long-term effects of simultaneous subconjunctival and subscleral mitomycin C application in repeat trabeculectomy.

PURPOSE: To assess the efficacy and safety of simultaneous mitomycin C application under conjunctival and scleral flaps in patients with repeat trabeculectomy. METHODS: A total of 44 patients (44 eyes) with previous failed filtering surgery were randomized to one of two groups. The both-flaps group comprised 22 patients (22 eyes) with trabeculectomy and intraoperative mitomycin C application under conjunctival and scleral flaps, whereas the subconjunctival group comprised 22 patients (22 eyes) with subconjunctival application of mitomycin C. Particular attention was paid to intraocular pressure, postoperative medications, visual acuity, filtering bleb appearance, and complications. The mean follow-up time was 38.18 +/- 12.48 months. RESULTS: The mean preoperative intraocular pressure decreased from 39.1 +/- 7.3 mm Hg to the postoperative level of 15.6 +/- 4.8 mm Hg in the both-flaps group (P = 0.014), and from 39.4 +/- 8.4 to 18.7 +/- 5.8 mm Hg in the subconjunctival group (P = 0.018). There was a statistically significant difference in intraocular pressure at all follow-up times, except at 1 week and 1 month postoperatively. Kaplan-Meier survival analysis showed there was no significant difference in total success rate (complete plus qualified success) between the two groups (P = 0.622, log-rank test). However, the two survival curves for the complete success subgroups (without additional medications) confirmed that mitomycin C applications under both flaps had a higher success rate than subconjunctival application (P = 0.043, log-rank test). No statistically significant difference in medications was present between the two groups, and no severe complications developed in either group. CONCLUSIONS: Trabeculectomy augmented with mitomycin C application at both sites could produce a greater lowering of intraocular pressure with low incidence of postoperative complications, and could provide an increased chance of long-term success. The procedure is effective and safe in patients with repeat trabeculectomy.

Adult↗
PubMed2003

Laser suture lysis after trabeculectomy.

PURPOSE: The author attempted to avoid ocular hypotony following a mitomycin-C trabeculectomy by controlling the interval between surgery and laser suture lysis. METHODS: When 10 seconds of digital pressure on the eye following a mitomycin-C trabeculectomy produced a 20% drop of the intraocular pressure, the decision of whether or not to perform laser suture lysis was delayed until the following examination. RESULTS: Twenty-nine consecutive eyes (27 patients) with primary open-angle glaucoma underwent mitomycin-C trabeculectomy in which laser suture lysis was required during the postoperative period to reach the target intraocular pressure. The eyes were classified by the severity of the glaucoma: mild, moderate, and severe. For moderate and severe glaucoma, an unqualified success was defined as an intraocular pressure of 10 +/- 2 mm Hg. A qualified success had an intraocular pressure of 5 to 7 mm Hg or 13 to 15 mm Hg. Failure was defined as an intraocular pressure less than 5 mm Hg or greater than 15 mm Hg. Fifteen eyes were called success, 7 eyes qualified success, and 7 eyes failure. When the final laser suture lysis was carried out within the first two postoperative months, two of the failure eyes sustained hypotony. If the final laser suture lysis had been carried out after the first two postoperative months, there were no eyes with hypotony. There was no statistical difference in the final intraocular pressure between the early laser suture lysis and late laser suture lysis groups. CONCLUSIONS: From this pilot study it would appear that delaying the final laser suture lysis following trabeculectomy (MMC) until after the second postoperative month may reduce the risk of hypotony without adversely affecting the final intraocular pressure.

Aged↗
PubMed2004

Encapsulated blebs following primary standard trabeculectomy: course and treatment.

PURPOSE: To investigate the incidence and course of encapsulated filtering blebs (EB) following primary standard trabeculectomy in eyes with non-complicated glaucoma. MATERIALS AND METHODS: Records of patients who were being followed-up in Ankara Numune Hospital, 1st Eye Clinic Glaucoma Department were analyzed and 183 eyes of 183 consecutive patients who underwent primary trabeculectomy without antimetabolites were enrolled in the study. RESULTS: Encapsulation developed in 14 (7.6%) of 183 eyes and identification of bleb encapsulation occurred at a mean follow-up time of 5.1 +/- 5.0 weeks (median = 4 weeks). Mean intraocular pressure (IOP) levels before, during, and after the encapsulated bleb phase were 14.1 +/- 3.6, 23.4 +/- 6.9, and 14.4 +/- 3.9 mm Hg respectively. All eyes responded to conservative medical treatment consisting of aqueous suppressants without digital massage, and encapsulation resolved after a mean duration of 8.3 +/- 4.6 weeks (median = 8 weeks). Patient age, gender, glaucoma diagnosis, and preoperative IOP levels were not significantly related with the occurrence of EB formation. There was no significant difference in the use of topical beta-blockers and miotics in patients that developed EB versus those who did not; however, EB developed only in eyes with prior beta-blocker therapy and no encapsulation occurred in the 16 eyes that had not received topical beta-blockers. Mean duration of follow-up was 45.3 +/- 30.7 months (12 to 127 months) in the group without encapsulation and 44.6 +/- 22.7 months (18 to 84 months) in the EB group. Overall success rates of trabeculectomies in eyes with and without EB were not significantly different (100% and 91.7%, respectively). Complete surgical success, however, without antiglaucomatous medications at the last visit was significantly lower in eyes with prior encapsulation (35.7% with EB, 63.9% without EB) (P = 0.014). CONCLUSION: Filtering bleb encapsulation following primary trabeculectomy responds well to conservative medical IOP-lowering therapy in eyes with glaucoma associated with elevated IOP.

Adult↗
PubMed2004

Bleb revision for hypotony maculopathy after trabeculectomy.

PURPOSE: To assess the efficacy of a bleb revision technique with regard to improvement in intraocular pressure (IOP) and visual acuity after hypotony maculopathy and to evaluate the influence of duration of hypotony on visual outcome. PATIENTS AND METHOD: : Retrospective review of a series of patients who underwent bleb revision for hypotony maculopathy (IOP less than 6 mm Hg and loss of two or more lines of central vision) following trabeculectomy. Bleb revision included excision of avascular bleb tissue, dissection posteriorly between conjunctiva and Tenon's capsule, and advancement and suturing of the conjunctiva at the limbus. RESULTS: Fourteen patients were included in the study. The average age was 49.8 years (range 18-85) and eight were female. Before trabeculectomy, the mean IOP was 23.2 +/- 11.8 mm Hg, and the visual acuity was 20/30-2 or better in 13 patients and 20/80 in one patient. The mean IOP before bleb revision was 1.07 +/- 0.73 mm Hg, and 12 patients had lost an average of 4.33 +/- 2.96 lines of visual acuity from baseline, while one had count fingers and another had hand motion vision. The final mean IOP after bleb revision was 11.07 +/- 3.08 mm Hg. Compared with visual acuity just prior to bleb revision, 12 patients regained an average best corrected vision of 3.08 +/- 2.67 lines, with seven returning to the pre-trabeculectomy vision level. The duration of hypotony prior to bleb revision was 1 to 24 months (average 8.36 months) with no correlation (correlation coefficient -0.13) between duration and visual outcome. CONCLUSION: Bleb revision for hypotony maculopathy following trabeculectomy is an effective technique for raising IOP and limiting visual loss, which is not influenced by duration of hypotony within the time frame of the study.

Adolescent↗
PubMed2005

Management of intracorneal bleb after trabeculectomy for congenital glaucoma.

PURPOSE: Congenital glaucoma is a well-recognized entity that can occur in the presence of anterior segment dysgenesis. Trabeculectomy is an accepted intervention in the management of congenital glaucoma. The surgical technique as well as complications is well described. METHODS: This is a case report of a 3-month-old girl with anterior segment dysgenesis and glaucoma. She was referred post-trabeculectomy with persistent corneal opacity to be considered for penetrating keratoplasty and was found to have intrastromal corneal bleb. RESULTS: Ultrasound biomicroscopy confirmed communication of the corneal bleb with the anterior chamber, and the bleb was treated by autologous blood injection at the trabeculectomy site, under acetazolamide cover. CONCLUSIONS: We present evidence suggesting that abnormal structure was the etiologic basis for corneal bleb formation and describe our management of this previously unreported complication of trabeculectomy.

Acetazolamide↗
PubMed2004

Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behçet disease.

PURPOSE: To determine the effect of intraoperative application of Mitomycin-C (MMC) with trabeculectomy in uveitic glaucoma associated with Behçet disease. MATERIALS AND METHODS: Twenty-six eyes of 26 patients with uveitic glaucoma associated with Behçet disease who underwent trabeculectomy with MMC between 1996 and 2001 were reviewed in this retrospective, noncomparative study. Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed to all patients. Main outcome measures were control of IOP, the number of antiglaucoma medications required to achieve the desired IOP, visual acuity and complications. The surgical success was defined as IOP less than 22 mm Hg and greater than 5 mm Hg without additional further glaucoma surgery or loss of light perception. RESULTS: The cumulative probability of success was 83.3% at 1 year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years after surgery. The mean follow-up was 40.0+/-18.0 months. At last follow-up 23% of the patients required no antiglaucoma medications. Best-corrected visual acuity improved or remained within two lines of preoperative visual acuity in 19 eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3 eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes 15.2%). The most common complications were cataract formation in 6 eyes (23.1%), bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%). Phthisis bulbi was found in one (3.8%) patient. CONCLUSION: Trabeculectomy and intraoperative application of MMC appears to provide long term safety and effectiveness in uveitic glaucoma associated with Behçet disease.

Adolescent↗
PubMed2005

Transconjunctival suture adjustment for initial intraocular pressure control after trabeculectomy.

PURPOSE: In an experimental human eye model of trabeculectomy, scleral flap suture adjustment allows predictable control of intraocular pressure (IOP). This approach had not previously been described in clinical use; we present a case series with the application of this technique. METHODS: A prospective, non-comparative interventional case series of consecutive patients undergoing trabeculectomy. Forty trabeculectomies were performed using a 3 mm x 4 mm scleral flap with two apical adjustable 10-0 nylon sutures under a fornix-based conjunctival flap. Intraoperatively the scleral flap sutures were tied tightly to appose the edges of the flap. All trabeculectomies were augmented with antimetabolite intraoperatively. On day one, patients with an IOP greater than 15 mm Hg had their suture tension adjusted to lower their IOP to a target range (10 to 15 mm Hg). Major outcome measures were IOP before and after adjustment and success at last follow-up (IOP < or = 15 mm Hg on no glaucoma medication and no clinically significant complications) without and with adjunctive needling. Other outcomes measured were postoperative complications, bleb needling, final bleb morphology, and visual acuity change from pre-operation to final follow-up. RESULTS: Average day one IOP was 14.8 mm Hg (standard deviation (SD) 7.8). Fourteen patients had a day one IOP over 15 mm Hg and underwent suture adjustment, lowering IOP to between 10 and 15 mm Hg. (Mean post adjustment IOP was 10.7 mm Hg (SD 3.6)). One patient had a conjunctival tear intraoperatively. Four patients had transient wound leaks. No patients had shallow anterior chambers. All but four had diffuse blebs at last follow-up. Success rate without any further surgical intervention was 75%, and success rate with adjunctive needling was 100%. The mean duration of follow-up was 6.3 months (range 1-12 months). CONCLUSION: The approach of tying scleral flap sutures tightly with transconjunctival adjustment of sutures if the IOP is greater than 15 mm Hg on day one allows excellent control of early postoperative IOP.

Adult↗
PubMed1989

The place of trabeculectomy in the management of primary open-angle glaucoma and factors favouring success.

Medical treatment has always been the mainstay in the management of primary open-angle glaucoma (POAG). Surgical intervention has been reserved for cases with intraocular pressures uncontrolled on medical therapy and/or progression of visual field loss. Following the introduction of trabeculectomy, there was a move toward earlier surgery in POAG with some advocating it as a primary procedure. However, others have emphasised the complications and unpredictability of trabeculectomy and use it only as a last resort. In this article the literature is reviewed and the factors that prevent complications and help ensure a successful result in trabeculectomy are considered. While the role of trabeculectomy as a primary procedure in POAG is debatable, the authors favour earlier surgical intervention rather than using surgery as a last resort.

Glaucoma, Open-Angle↗
PubMed2006

Immediate postoperative intraocular pressure measurements after trabeculectomy with releasable sutures.

BACKGROUND: To assess the practicality of same-day intraocular pressure (IOP) review following trabeculectomy with releasable sutures. It is a prospective observational case series study. METHODS: 40 eyes of patients undergoing inpatient trabeculectomy for glaucoma optic neuropathy. IOP measurement at 2, 4, 8, 12 and 24 h following trabeculectomy with releasable sutures. Slit-lamp microscopy documenting surgical complications. RESULTS: Three patients required intervention within the first 24 h and four patients at 24 h because of raised IOP. Investigating pressure outcomes of low (<8 mmHg) and high (>21 mmHg) the sensitivity and specificity of IOP assessments at 2, 4, 8 and 12 h were compared with a 'gold standard' of IOP at 24 h postoperatively. False negative results persist at time periods for low IOP and are absent for high IOP only at 8 h postoperatively. There is a marked change in IOP over the first 24-h period in some patients, both from high to low and from low to high levels. CONCLUSIONS: Same-day review of trabeculectomy is not a practical proposition as a policy for a unit with present operative techniques. Indeed the finding of transient high pressures during the first 24 h in some cases suggests that in those patients for whom there is concern (mainly those with severe disc cupping at the time of surgery) at least one IOP check during the first 24 h postoperatively may be warranted in addition to the 24-h postoperative check.

Adult↗
PubMed1995

The effect of flat anterior chamber on the success of trabeculectomy.

The authors reviewed 70 eyes of 59 patients who underwent trabeculectomy. We divided the eyes into the flat anterior chamber group (23 eyes) and formed anterior chamber group (47 eyes, control group). The influence of clinical variables on the development of flat anterior chamber, and the effect of flat anterior chamber on the success of trabeculectomy were evaluated. The two groups were similar in terms of many variables, but the preoperative intraocular pressure (27.1 +/- 15.4 vs. 18.1 +/- 8.7 mmHg), incidence of cataract progression (9/18 vs. 10/44) and choroidal detachment (5/23 vs. 2/47) were higher in the flat anterior chamber group (p < 0.05). The overall success rates for the follow-up period of 30 months were similar between the two groups (p > 0.05). However, the short-term (2 to 8 months) postoperative success rates were lower in the flat anterior chamber group (p < 0.05). The development of flat anterior chamber following trabeculectomy can be reduced by lowering the preoperative intraocular pressure, and flat anterior chamber may be harmful to the postoperative course of trabeculectomy.

Anterior Chamber↗
PubMed2005

Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study.

PURPOSE: To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. METHODS: The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. RESULTS: Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. CONCLUSION: Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

Aged↗
PubMed1991

Trabeculectomy with 5-fluorouracil.

The effect of subconjunctival injection of 5-fluorouracil (5-FU) after trabeculectomy was studied retrospectively in 205 eyes of 168 patients. A life table analysis of the surgical outcome was based on the type of glaucoma and age related differences, and a comparison was made with patients who had trabeculectomy without subconjunctival 5-FU. The success rate at 30 months after trabeculectomy with 5-FU therapy was considerably higher in primary open-angle glaucoma at 93.6% (72.7%), secondary glaucoma at 88.9% (72.4%), and refractory glaucoma at 72.2% (32.5%) with (or without) the use of ocular hypotensive drops when compared with historical control groups treated without 5-FU (60.0% (41.7%), 35.5% (24.0%), and 18.0% (8.0%), respectively). In patients aged over 70 years, no statistically significant improvement could be demonstrated with the use of 5-FU after trabeculectomy in primary open-angle glaucoma. Our study may provide data on the appropriate dosage and indications for the use of this drug after glaucoma surgery.

Aged↗
PubMed2005

Trypan blue identifies antimetabolite treatment area in trabeculectomy.

AIM: Colourless solutions of mitomycin C (MMC) and 5-fluorouracil (5-FU) are widely used during trabeculectomy to inhibit postoperative scarring. The poor visibility of these agents on the eye has several drawbacks including the inability to accurately assess the area of treatment. This study examined the utility of using trypan blue dye to colour antimetabolites used during trabeculectomy and the effect of trypan blue on antimetabolite cytotoxicity in vitro. METHODS: For in vitro experiments, MMC (0.4 mg/ml) and 5-FU (25 mg/ml) were reconstituted with or without trypan blue. A lactate dehydrogenase release assay was used to measure drug induced cell death and viable cell number 7 days after treatment. For clinical assessment, trypan blue 0.1% was added to MMC and 5-FU to final concentrations of between 0.01% and 0.05%. The mixture was applied to Tenon's capsule and sclera via pre-wet or into dry 5x8 mm sponges (MMC and 5-FU) for 3 minutes or by direct subconjunctival injection after completion of surgery (5-FU). Twenty two consecutive patients undergoing trabeculectomy either with or without trypan blue were followed for 2 years postoperatively. RESULTS: The addition of 0.05% trypan blue to MMC or 5-FU did not alter MMC induced cell death or the number of viable fibroblast in vitro. In vivo, trypan blue clearly delineated the antimetabolite treatment area and facilitated control of excess antimetabolite at the wound margins as well as sponge removal. With direct subconjunctival injection, total staining area varied for a given volume with location of the needle tip. Any leakage from the injection site could be easily seen. No adverse effects attributable to trypan blue were found in 2 years of follow up. CONCLUSIONS: Trypan blue permits delineation of antimetabolite/tissue interactions without affecting cytoxicity for the assays investigated. Trypan blue can be used to visualise antimetabolite soaked sponges, estimate treatment area, and show areas of unintended tissue contact during trabeculectomy. The addition of trypan blue to antimetabolites has potential benefits in clinical, research, and teaching aspects of ocular surgery and therapy.

Aged↗
PubMed1994

Effect of trabeculectomy on pulsatile ocular blood flow.

Trabeculectomy, despite producing an effective reduction in intraocular pressure, may not prevent continued visual field loss. This may be because of the presence of other factors in the pathogenesis of glaucoma. Vascular factors have been suggested as being particularly important. To study the effect of trabeculectomy on ocular blood flow the technique of ocular pulse analysis has been used to derive a measure of pulsatile ocular blood flow in 17 patients (average age 65.6 (SD 1.8) years) undergoing trabeculectomy. A significant increase in pulsatile ocular blood flow of 29% was observed in the group as a whole in the standing position following operation but in some individuals blood flow changed only slightly despite a large reduction in intraocular pressure. The significance of these findings in relation to the prognosis of visual field preservation following trabeculectomy is discussed.

Aged↗
PubMed2001

Optic disc changes following trabeculectomy: longitudinal and localisation of change.

AIMS: To determine whether there were any changes in the optic disc at 2 years after trabeculectomy. To determine the factors that most influenced change and whether change was localised to any region of the optic disc. METHODS: 95 patients undergoing routine trabeculectomy as part of the ongoing Moorfields/MRC 5-fluorouracil trial were recruited into the study. Eyes were imaged preoperatively (4 (SD 3) weeks) with the Heidelberg retina tomograph (HRT, Heidelberg Engineering), and at 3 months (SD 2 weeks), 1 year (SD 1 month), and 2 years (SD 1 month) after surgery. Parameters investigated for change were rim area, rim volume, and maximum cup depth. The predefined segment analysis available on the HRT analysis software was used to determine segmental change. RESULTS: The images of 70 patients were analysed. Intraocular pressure reduced from 22.25 (SD 3.76) mm Hg, at the time of preoperative imaging to 15.27 (SD 4.96) mm Hg at 3 months, 14.38 (SD 3.89) mm Hg at 1 year, and 13.80 (SD 3.54) mm Hg at 2 years after trabeculectomy. An increase in rim area and rim volume was present at all time points after surgery, but was only found to be statistically significant at 2 years after surgery. Maximum depth of cup reduced by month 3 and month 12, but showed a slight increase at 2 years after surgery, although this was still lower than the preoperative measure. Segmental analysis found a significant change in rim volume in the nasal, inferonasal, superonasal, and superotemporal regions at 2 years after surgery. No significant regional localisation for change was found at any other time point or in any other parameter investigated. CONCLUSIONS: Reversal of disc cupping is present at 2 years after trabeculectomy. The factor most influencing change is reduction of intraocular pressure. Segmental analysis showed that change in rim volume was greatest in the nasal, inferonasal, superonasal and superotemporal regions at 2 years.

Aged↗
PubMed2001

A randomised trial of the effect of intraoperative 5-FU on the outcome of trabeculectomy in east Africa.

AIMS: To determine if intraoperative application of 5-fluorouracil (5-FU) improves the prognosis for trabeculectomy in east Africa. METHODS: 68 eyes with chronic open angle glaucoma were included in a randomised trial of intraoperative 5-FU versus placebo. Main outcome measures were intraocular pressures at 6 months and probability of failure at 2 years. RESULTS: 180 days after surgery the mean intraocular pressure (IOP) was 17.4 (SD 6.1) mm Hg in the placebo group and 16.9 (5.8) mm Hg in the 5-FU group. By 2 years after trabeculectomy, the probability of successful IOP control was 70.6% in the placebo group, and 88.8% in the 5-FU group. The placebo group was 2.18 times (95% CI 0.67 to 7.15) more likely to require additional IOP lowering procedures than the 5-FU group. Among patients followed for 2 years, 30% lost 0.3 logMAR units of visual acuity. CONCLUSIONS: Trabeculectomy in Africa has an acceptable success rate which may be enhanced by the use of intraoperative 5-FU. It is estimated that this would cost approximately 1.25 pounds sterling per trabeculectomy failure prevented.

Antimetabolites↗
PubMed2003

Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy.

AIM: To compare the long term mean intraocular pressure (IOP) reduction after non-augmented single site phacotrabeculectomy with that after trabeculectomy and to determine the relation between preoperative IOP and IOP reduction. METHODS: A group of 44 consecutive patients with chronic open angle glaucoma who underwent phacotrabeculectomy were matched to a trabeculectomy control group and the results of surgery were compared. Linear regression analysis of preoperative IOP and IOP reduction was undertaken. RESULTS: The mean IOP reduction was significantly less in the phacotrabeculectomy group (6.7 (SD 2.1) mm Hg) than in the trabeculectomy group (11.0 (1.4) mm Hg) (p=0.0017). There was a significant difference in surgical success between the groups. The preoperative IOP was significantly related to the postoperative reduction in IOP in both groups (p<0.001). CONCLUSIONS: In elderly white patients with chronic open angle glaucoma, phacotrabeculectomy is not as effective as trabeculectomy in reducing IOP. In both procedures the magnitude of IOP reduction is proportional to the preoperative IOP.

Aged↗