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PubMed2004

Otago Glaucoma Surgery Outcome Study: long term results of cataract extraction combined with Molteno implant insertion or trabeculectomy in primary glaucoma.

BACKGROUND/AIMS: To describe the long term results of cases of cataract extraction combined with either Molteno implant insertion or trabeculectomy for primary open angle glaucoma. METHODS: This prospective case series followed cases which had cataract extraction and Molteno implant insertion (45 eyes) or trabeculectomy (94 eyes) followed up for a mean of 5.3 years and 3.9 years respectively. RESULTS: Cataract extraction and Molteno implant insertion or trabeculectomy controlled the intraocular pressure at 21 mmHg or less with a probability of 1.00 (95% CI 0.93 to 1.00) at 10 years or more after operation and 0.94 (95% CI 0.89 to 0.99) and 0.73 (95% CI 0.46 to 0.99) at five and 10 years after operation respectively. CONCLUSIONS: Cataract extraction combined with insertion of Molteno implants or trabeculectomy controlled the intraocular pressure in 100% (45/45) and 94% (88/94) of cases respectively.

Aged↗
PubMed1998

Trabeculectomy with long-term-stored mitomycin C in West Indian population.

We investigated the outcome of trabeculectomy with stored mitomycin C (MMC) in a black Caribbean population on the island of Dominica. Ten eyes (9 patients) underwent trabeculectomy with MMC (0.5 mg/ml for 3-6 min) that had been stored for up to 17 months at 4 degrees C. The preoperative intraocular pressure of (mean +/- SD) 32.8+/-7.5 mm Hg on 2.6 medications decreased to 9.5+/-3.2 mm Hg on 0.2 medications after a mean follow-up time of 14.2 months (range 7-25). Nine eyes did not receive medications postoperatively. Complications observed included bleb infection (1 eye) and late bleb leak (1 eye); 2 eyes developed cataract. Nine blebs had typical clinical features of blebs after trabeculectomy with adjunctive MMC. We conclude that long-term-stored MMC may be beneficial as adjunctive treatment in initial trabeculectomy in this population.

Adult↗
PubMed1998

Ultrasound-biomicroscopic evaluation of filtering blebs after laser suture lysis trabeculectomy.

UNLABELLED: Sometimes in glaucomatous patients treated with trabeculectomy there is no correlation between bleb shape and intra-ocular pressure (IOP). In this study we evaluated the ultrasound biomicroscopy (UBM) features of filtering blebs after laser suture lysis (LSL) trabeculectomy in order to analyse whether its ultrasound-biomicroscopic image can predict the function (IOP). METHODS: The Humphrey ultrasound biomicroscope, using a high-frequency (50-Mhz) probe, provides high-resolution images of filtering blebs. A total of 103 filtering blebs after LSL trabeculectomy were analysed by UBM. Taking into account the characteristics of internal reflectivity and scleral flap, we classified the blebs into three groups (good, fair, poor) that indicate the bleb function and correlated this UBM pattern with the IOP control (good, borderline, failure). RESULTS: There was a statistically significant corelation between the UBM classification of function and the IOP control level. Both well-functioning and failed trabeculectomies could be identified by UBM. The UBM images of eyes with good IOP control are characterized by better visibility of the route under the scleral flap and a low reflectivity inside the bleb. CONCLUSIONS: In accordance with previous studies, we believe that UBM can be a useful method to study and explain the mechanisms of filtering structures and, together with IOP control, to evaluate the bleb function.

Adult↗
PubMedDate not supplied

Aqueous dynamics in experimental ab externo trabeculectomy.

PURPOSE: This study assessed the decrease in intraocular pressure (IOP), the residual outflow resistance of the trabeculum and the filtration site by histology in enucleated pig and human eyes after ab externo trabeculectomy. METHOD: Measurement of the resistance to aqueous outflow was performed using the constant pressure method before and after ab externo trabeculectomy. RESULTS: The outflow facility was 0.31 +/- 0.13 microl/min/mm Hg in pig eyes and 0.24 +/- 0.08 microl/min/mm Hg in human eyes before surgery, and 79.0 +/- 47. 6 microl/min/mm Hg in pig eyes and 6.33 +/- 6.67 microl/min/mm Hg in human eyes after ab externo trabeculectomy. On histological examinations the aqueous outflow pathway was seen to be at the level of the residual trabecular meshwork. CONCLUSION: This study showed that ab externo trabeculectomy significantly lowers IOP and improves outflow facility in enucleated pig and human eyes.

Animals↗
PubMedDate not supplied

Reopening of failed trabeculectomies with ab interno Nd:YAG laser.

PURPOSE: To test the efficacy of ab interno Nd:YAG laser in reopening closed trabeculectomies and to specify the factors influencing the success or failure of the revision. METHODS: 27 patients underwent ab interno revision of their failed trabeculectomies with a Q switched, single-shot Cooper Vision 2500 Nd:YAG laser. The cause of obstruction was iris in 12 patients, transparent membrane in sclerectomy in 8 and fibrosis of the scleral flap in the remaining 7. The pre-laser IOP ranged from 28 to 40 mmHg, the patients' ages from 42 to 75 years and the time between the trabeculectomy failure and the revision from 3 to 17 months. The total energy given to each eye per session, using a gonioscope, ranged from 30 to 1185 mj. RESULTS: Post-laser follow-up ranged from 6 to 32 months. IOP was controlled in 20 of 27 cases. CONCLUSIONS: We believe that factors influencing the success of the revision are the patient's age, the kind and location of the obstacle and the time elapsed between the failure of the trabeculectomy and the Nd:YAG revision.

Adult↗
PubMedDate not supplied

Use of amniotic membrane in trabeculectomy for the treatment of glaucoma: a pilot study.

PURPOSE: To compare the safety and efficacy of human preserved amniotic membrane (AM) in the trabeculectomy for treatment of primary open-angle glaucoma. METHODS: A prospective, randomized clinical trial compared primary trabeculectomy with amniotic membrane (study group) and without amniotic membrane (control group) in the treatment of the glaucoma. Intraocular pressure (IOP), number of glaucoma medications and appearance of the bleb were compared between the two groups. Thirty-two patients divided into two groups of 16 patients were followed for a period of 12 months. RESULTS: The difference of the mean postoperative intraocular pressure between groups was not statistically significant (15.19 +/- 3.33 in the control group and 12.81 +/- 2.48 in the study group p=0.297) at one year follow-up. Postoperative number of medications decreased in both groups (p<0.001 and p=0.007, study group and control respectively). At the end of a 12-month follow-up period, nine eyes (56.25%) showed thin, avascular blebs in the study group as compared to only one eye (6.25%) in the control group. CONCLUSIONS: Trabeculectomy with amniotic membrane and standard trabeculectomy promote lower postoperative intraocular pressure although results showed no statistically significant difference between groups regarding postoperative intraocular pressure after one year follow-up.

Amnion↗
PubMed1999

Late bleb-related endophthalmitis after trabeculectomy with mitomycin C.

To present two cases of delayed-onset postoperative endophthalmitis following trabeculectomy combined with mitomycin C for secondary glaucoma after penetrating keratoplasty. We retrospectively evaluated two patients with late endophthalmitis after trabeculectomy combined with intraoperative mitomycin C application. Both patients underwent trabeculectomy for uncontrolled glaucoma following penetrating keratoplasty and they developed thin-walled cystic blebs. Intraocular pressure was normal, and grafts remained clear postoperatively. Severe endophthalmitis with hypopyon developed at 3 and 7 months postoperatively. Both patients had concomitant bleb infection. They underwent vitreous sampling and intravitreal injection of vancomycin and amikacin and were given topical fortified and systemic antibiotic therapy. Intravitreal injection was repeated once in both patients. Cultures grew Streptococcus pneumonias in one and Staphylococcus aureus in the other. Although the treatment of endophthalmitis was successful in both patients, only one of them achieved useful vision (20/40). For the other patient who had been infected with S. pneumoniae, vision was light perception. Delayed-onset endophthalmitis following trabeculectomy with mitomycin C application is a severe and vision threatening complication. It seems that the development of thin cystic filtering blebs secondary to intraoperative mitomycin C application may be a predisposing factor for bleb-related late endophthalmitis.

Adult↗
PubMed1998

Cataract extraction and lens implantation with and without trabeculectomy: an intrapatient comparison.

OBJECTIVE: To determine whether cataract extraction and lens implantation combined with trabeculectomy provides better long-term results than cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract randomly selected to receive surgery with trabeculectomy in one eye and without in the other. METHODS: A prospective, randomized clinical trial involving 35 patients with bilateral symmetric primary open-angle glaucoma and visually disabling cataracts with procedures performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases. RESULTS: After an average of 87 months of follow-up, cataract extraction and lens implantation reduced intraocular pressure 4.4 mm Hg, reduced number of medications by 1.28, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in 6 of 35 eyes. After an average of 80 months of follow-up, cataract extraction, lens implantation, and trabeculectomy reduced intraocular pressure 8.2 mm Hg, reduced number of medications by 1.76, increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in 1 eye. Both groups had similar improvement in visual acuity and perioperative complications. CONCLUSIONS: Extracapsular cataract extraction, lens implantation, and trabeculectomy is a complex procedure that was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered in patients who may not be able to comply with a complex medical regimen, in whom pressure elevation in the immediate postoperative period would be undesirable, or in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.

Aged↗
PubMedDate not supplied

Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome.

OBJECTIVE: To assess the long-term clinical outcome of primary trabeculectomy in young adults, and evaluate potential risk factors contributing to failure of filtering surgery. MATERIAL AND METHODS: A retrospective review was carried out of the charts of all glaucomatous patients between the age of 15 to 45 years. These patients had no history of previous extra- or intraocular surgery and had undergone primary trabeculectomy without the use of antimetabolites from January 1988 to January 1995 at the University Eye Hospital of Cologne. A total of 51 eyes of 45 patients fulfilled the inclusion criteria. There were no drop-outs from follow-up. Mean follow-up was 5.2 years (range, 2.5 to 9.5 years). Outcome was defined as a success when postoperative intraocular pressure (IOP) was 21 mm Hg or lower. If further glaucoma medication was required the outcome was described as a qualified success, and when the patient was free of medication the outcome was considered a complete success. RESULTS: Using the Kaplan-Meier survival curve, cumulative life-table success rates were 88% at 1 year (n = 51), 82% at 3 years (n = 47), 76% at 5 years (n = 26), and 70% at 7 years (n = 22). At final visit 71% (n = 36) were classified as successes, with 54% (n=30) being successful without adjunct medication. Seventeen percent (n = 6) required additional topical medication. Previous laser trabeculoplasty and an IOP greater than 40 mm Hg during the course of the disease was found to adversely affect the outcome. Eyes with iridocorneal epithelialopathy (ICE) syndrome, Rieger's anomaly, and uveitic glaucoma failed more frequently than those with juvenile, pigmentary, and primary open-angle glaucoma (POAG). Younger age (< 30 years) was not associated with a lower success rate after controlling for glaucoma category. CONCLUSION: The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older adults. Primary trabeculectomy in young patients may have a favorable outcome even without antimetabolite therapy.

Adolescent↗
PubMed2000

[Trabeculectomy in black Africans in primary open angle glaucoma].

PURPOSE: To assess simple trabeculectomy in black Africans with open angle glaucoma. METHODS: We studied retrospectively 80 eyes of 62 patients with primary open angle glaucoma operated by Cairn's trabeculectomy without adjunction of antimetabolites. Thirty seven eyes had a limbal-based conjunctival flap and the others 43 had a fornix-based conjunctival flap. Failures and success were assessed with the Kaplan-Meier's method. RESULTS: Patients were all seen at least 12 months after surgery. The mean follow up was 24 months. At mid-term survey we found complications to be frequent. Pathological blebs occurred in 22.5% (18 cases). The survival probability grew shorter with time. Only 44% of patients were reviewed at 36 months and 29% at 48 months. The success rate (IOP less than 21 mmHg of all glaucoma medications) varied according to the conjunctival flap. It was respectively at 12 months, 24 months and 36 months: 97%, 70 % and 54% with limbal-based flap, and 46%, 18% and 18% with fornix-base flap. The overall rate of tonometric failures was 33.75%. Failures were more often with fornix- based flap (85%). Generally they set in before one year of survey. This was so in 91% of absolute failures and in 87% of relative failures. The failures rate seems to increase with topical polytherapy given more than 12 months before operation. CONCLUSIONS: Trabeculectomy with limbal-based conjunctival flap is at mid-term follow up successful in black Africans. However the following up difficulties in Africa makes it a too delicate assessment objective for long-term results of trabeculectomy.

Adolescent↗
PubMed2000

[Trabeculectomy as the initial procedure in primary congenital glaucoma].

PURPOSE: To estimate the effectiveness of trabeculectomy performed in buphthalmic eyes. MATERIAL AND METHODS: 42 eyes of 24 children, 14 boys and 10 girls. There were 18 children (32 eyes) operated on at the age from 7 days to 12 months (group I) and 6 patients (10 eyes) at the age from 3 to 7 years (group II) with primary congenital glaucoma. Corneal diameter ranged from 11.5 to 15 mm in infants, in 10 eyes of 6 children elder than 2 years it was from 13 to 15 mm. The axial length of eyeballs was from 19 to 23.5 mm. Forty five trabeculectomies were performed, in 3 cases they were repeated two and six years after the first procedure. Follow up was from 1 year to 22 years, mean 82 months, 7 years of group I, 6 years of group II. RESULTS: 29 of 42 eyes (64.2%) with intraocular pressure varied between 8 and 21 mm Hg, other eyes required additional local antiglaucoma treatment. Normal IOP was obtained in 95.2% of eyes. Trabeculectomy normalized IOP in 68.9% eyes of infants (group I), whereas in elder children the percentage came up to 50 (group II). In other eyes pharmacological agents decreased IOL to values below 21 mm Hg, in the group I in 97% of eyes and in the group II in 90% of cases. CONCLUSION: Trabeculectomy performed as a first procedure in primary congenital glaucoma is effective in infants and older children with buphthalmos in long-term follow-up. The necessity to perform this operation in very small children and even neonates does not always mean poor prognosis, and intraocular pressure can be stabilized at safe level for many years.

Age Factors↗
PubMed1999

[Long-term effect of extra-trabeculectomy in treatment of congenital glaucoma].

OBJECTIVE: To assess the long-term effect of extra-trabeculectomy in treatment of congenital glaucoma. METHODS: 29 patients (47 eyes) with congenital glaucoma having undergone extra-trabeculectomy were followed up for over 5 years. RESULTS: Success rates after single surgery were 70.2% at 6 months, 63.8% at 12 months, 57.5% at 18 months and 55.3% at 24 months. Re-elevation of intraocular pressure (IOP) all happened within 2 years after surgery. 14 eyes underwent second trabeculectomy, and 7 eyes (50.0%) were successful the total success rate was 70.2%. The naked visual acuity of 12 eyes (36.0%) among successful eyes was >or= 0.5. All the diseased eyes were myopic (-0.50 to -25.00 D). CONCLUSION: Follow-up of trabeculectomy should be emphasized within 2 years after surgery. Ametropic and anisometropic amblyopia should be corrected promptly after surgery.

Child, Preschool↗
PubMed2001

[Trabeculectomy and nonpenetrating surgery in glaucoma].

The purpose of the study is to compare the efficiency of classical trabeculectomy and with the punch and nonpenetrating deep-sclerectomy in patients with primary open angle glaucoma. The studied groups comprise patients with uncontrolled intra-ocular pressure with medical therapy and/or laser. The results of the study emphasize the following conclusions: the decrease of intra-ocular pressure is comparable in classical trabeculectomy and with punch the decrease of intra-ocular pressure is comparable in classical trabeculectomy and nonpenetrating surgery. we consider the non penetrating surgery an interesting alternative to the classical trabeculectomy, with better control of intra-ocular pressure the complications of non penetrating surgery are reduced.

Glaucoma, Open-Angle↗
PubMed2002

Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.

PURPOSE: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. METHODS: We studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 through December 1999. The main outcome measures were postoperative intraocular pressure (IOP), corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anaesthetic morbidity and mortality were also analysed. RESULTS: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anaesthesias. The mean follow-up period was 16.33 +/- 16.22 months. The IOP reduced from 26.4 +/- 5.9 mmHg to 13.5 +/- 4.5 mmHg, with a mean percentage reduction of 46.2 +/- 23.7 (P < 0.0001). The success (IOP < 16 mmHg) probabilities were 90.9%, 88.0% and 69.3% at first, second and third year respectively (Kaplan-Meier analysis). The success probability of 69.3% obtained at third year was maintained till 6 years of follow-up. One hundred and sixty six (76.1%) eyes had significant corneal oedema. Postoperatively, the cornea cleared in 93 (57.8%) eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%). Postoperatively, 18 (8.3%) eyes developed shallow anterior chamber and 6 (33.3%) of them required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6%) patients and all were successfully resuscitated. The most serious post-anaesthetic complication was cardio-pulmonary arrest that occurred 5 hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (2 and 4 hours respectively). The child who had delayed recovery by 2 hours survived and has completed 3 years of follow-up while the other child expired 48 hours later. CONCLUSION: Simultaneous bilateral primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma. It obviates the need for long second anaesthesia with its attendant risks. It offers several other benefits to the patients and families.

Child↗
PubMed2002

Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report.

PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG.

Adult↗
PubMed1998

[Clinical research of trabeculectomy on outpatients].

PURPOSE: To investigate the feasibility of Trabeculectomy on outpatients. METHODS: Postspectively compared and discussed the surgery effect and complications of trabeculectomy on 38 eyes of 27 outpatients with those on 38 eyes of 30 inpatients. All the surgeries were performed by the same surgeon in the same period. RESULT: The IOP of outpatients' group after one week, one month, three months or more are respectively 1.4800 +/- 0.5977 kPa, 1.8379 +/- 0.5517 kPa, 1.9650 +/- 0.4879 kPa, while the inpatients' group are 1.3468 +/- 0.5994 kPa, 1.7737 +/- 0.5177 kPa, 2.0144 +/- 0.5447 kPa. t-test has shown that the differences of the IOP after the surgery, the surgery effect and complications of trabeculectomy between the outpatients and the inpatients had no significance. CONCLUSION: Trabeculectomy on outpatients in hospital with satisfied facility would be effective, safe and feasible.

Adolescent↗
PubMed2002

[Eye growth in children with primary congenital glaucoma after trabeculectomy].

PURPOSE: Evaluation of the influence of intraocular pressure (IOP) after trabeculectomy on the axial length and refraction of eyeballs in children with primary congenital glaucoma. MATERIAL AND METHODS: Thirty six eyes of 23 children at the age from 7 days to 6.5 years (mean 17.1 months), were examined. Measurements of corneal diameter, axial length, IOP and refraction were done before trabeculectomy and in the long-term follow-up (mean 7.9 years) after surgery. RESULTS: Horizontal corneal diameter didn't change and ranged from 10 to 15 mm, mean 13.22 mm. Mean value of axial length before trabeculectomy was 22.45 mm and 23.27 mm at last visit. The difference was statistically significant. The axis decreased in 3 eyes, was the same in 3 eyes. In the others the eye growth changed proportionally to the age of child. IOP values were statistically lower after surgery (mean 16 mmHg) than before treatment (mean 35.51 mmHg). There was no correlation between IOP and axial length of eyeballs (p = 0.69) and between IOP and refraction changes (p = 0.42) in the long-term follow-up. CONCLUSIONS: There is small influence of normalised IOP after trabeculectomy on size of eyeballs and refraction in children with primary congenital glaucoma. The development of eyeballs even buphthalmic is proportionally to the age.

Child↗
PubMed2003

[Trabeculectomy combined with mitomycin C and removed suture in glaucoma].

PURPOSE: To study the clinical effect of trabeculectomy combined with Mitomycin C and removed suture. METHODS: Seventy-five patients (99 eyes) with glaucoma were randomized into two groups: a controlled group underwent normal trabeculectomy, an observed group with trabeculectomy. The intraocular pressure (IOP), the anterior chamber depth, the filtering blebs, the visual acuity and other ocular complications were measured and compared between the two groups. RESULTS: The incidence of postoperative low IOP, shallow anterior chamber, the visual acuity loss and other complications in the observed group were less than those in the controlled group. CONCLUSION: Trabeculectomy could effectively reduce the incidence of postoperative complication by controlling the amount of aqua oculi outflowing. It is worthy of application in glaucoma surgical operation.

Adult↗