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PubMed1996

Results of combined trabeculectomy and phacoemulsification via tunnel incision.

Currently a cataract is usually surgically treated by phacoemulsification via tunnel incision. In cases of coexisting cataract and glaucoma a combined surgical procedure is desirable. We combine cataract and filtering surgery by simply dissecting a 1 x 1-mm piece from the inner tunnel lamella of a standard corneoscleral tunnel. The results of treatment of the first 20 eyes by the proposed combined procedure were compared with the results of traditional phacoemulsification and traditional trabeculectomy. With regard to visual acuity, combined surgery was as good as traditional phacoemulsification via tunnel incision. In terms of the regulation of intraocular pressure, combined surgery was as good as traditional trabeculectomy. As with trabeculectomy, mild early postoperative complications occur frequently, which require intensive post-operative care. Thus, the combination of trabeculectomy and phacoemulsification via tunnel incision proved to be a successful technique for the surgical treatment of combined cataract and glaucoma.

Aged↗
PubMed1997

[Corneal astigmatism after trabeculectomy].

PURPOSE: The aim of the present study was to investigate the effect of conventional and mitomycin trabeculectomy on the corneal astigmatism. SUBJECT AND METHODS: Measurements with the use of computer-assisted videokeratography (Eye-Sys) were performed in 34 glaucoma patients who underwent trabeculectomy. Color-coded topography maps were analyzed to obtain astigmatic data. RESULTS: The mean surgically-induced astigmatism in conventional trabeculectomy group was 2.2 D and in the mitomycin group 4.0 D, 1 day post-op, 1.3 D and 3.0 D after 10 days and 0.4 D and 1.1 D after 3 months, respectively. CONCLUSION: There was an apparent correlation between the amount of induced astigmatism and the use of mitomycin. This may be related to the impaired healing process of trabeculectomy wound and lower intraocular pressure in the mitomycin group.

Astigmatism↗
PubMed1998

Delayed corneal epitheliopathy after antimetabolite-augmented trabeculectomy.

PURPOSE: The authors describe the first case of delayed antimetabolite-related corneal epithelial toxicity after trabeculectomy and its successful treatment with limbal stem cell transplantation. METHODS: A 73-year-old woman underwent trabeculectomy with intraoperative mitomycin C. After surgery she received six 5-mg injections of subconjunctival 5-fluorouracil (5-FU) adjacent to the bleb. RESULTS: The patient had a functioning trabeculectomy and clear cornea until 30 months after surgery, at which time she developed a nonhealing superior corneal epithelial defect. After 4 months of conservative medical management, an autologous limbal stem cell transplantation was performed. The epithelial defect resolved completely within 1 week of limbal stem cell transplantation. CONCLUSIONS: Delayed corneal epithelial toxicity may be a late complication of antimetabolite-augmented trabeculectomy.

Aged↗
PubMed1986

Trabeculectomy with the use of sodium hyaluronate. A prospective study.

The effect of sodium hyaluronate (Healon) on the post-operative course and IOP 1 week and 1 month after trabeculectomy is reported. Twenty-nine eyes of 23 patients with open-angle glaucoma (10 simple, 11 capsular and 8 secondary glaucoma) were operated with the use of sodium hyaluronate. The study was prospective. For comparison, 29 eyes of 21 age- and sex-matched patients with glaucoma, operated during the pre-Healon period were selected. Patients in the study group were operated by the same surgeon and in the control group by different senior staff members. The method for trabeculectomy is described. IOP decrease was 56 and 54% in the H- and control group. No differences in post-operative pressure level existed between the different types of glaucoma. Shallow or flat chamber occurred frequently in both groups, but had a greater incidence in the control group. Sodium hyaluronate seems to prevent early excessive filtration. In five eyes of both groups choroidal detachment was simultaneously present. The incidence of choroidal detachment was the same as the overall incidence of this complication in this clinic. Post-operative pressure rise of greater than 30 mmHg after restoration of a flat chamber was more frequent in the control series. Sodium hyaluronate is useful in trabeculectomy. It prevents collapse of the anterior chamber and hyphema during the operation, it stabilizes early post-operative pressure and prevents excessive filtration combined with shallow or flat anterior chamber. It does not prevent choroidal detachment after trabeculectomy.

Adult↗
PubMed1979

Trabeculectomy versus Scheie's operation: a comparative retrospective study in open-angle glaucoma in Kenyans.

A comparative retrospective study was performed on 39 patients with open-angle glaucoma in whom the right eye was subjected to Scheie's operation, the left to trabeculectomy. Trabeculectomy without the use of additional therapy or reoperation brought the intraocular pressure to under 22 mmHg in 80% of the cases compared with 74% treated by Scheie's operation. Reduction of visual acuity postoperatively was 4 times more frequent with Scheie's operation than with trabeculectomy. A report on a second group of patients in whom 47 trabeculectomies were performed is also given.

Adult↗
PubMed1981

A comparison between peripheral iridectomy with thermal sclerostomy and trabeculectomy: a controlled study.

In 15 patients with primary open-angle glaucoma who required surgery in both eyes because of progressive glaucomatous disease a peripheral iridectomy with thermal sclerostomy was performed in one eye and a trabeculectomy in the other eye, the choice of procedure being determined randomly. In all 15 cases at one year and 13 cases at 5 years after operation the immediate complication rate was higher in patients receiving peripheral iridectomy with thermal sclerostomy. The average final level of intraocular pressure (on no treatment) was 16 mmHg in patients receiving peripheral iridectomy with thermal sclerostomy and 22 mmHg in those in whom a trabeculectomy was performed. The control of disease was the same in both groups, there being an improvement in the visual field in approximately one-third of all cases and stability of the visual field in all other cases except for one. However, twice as many patients after trabeculectomy required additional medical therapy to maintain the intraocular pressure in a range that was considered satisfactory. Stability of intraocular pressure was virtually the same in both groups. The mechanism of control of intraocular pressure in patients receiving peripheral iridectomy with thermal sclerostomy appeared to be gross filtration in all cases, whereas such gross filtration was observed in only 2 eyes in which a trabeculectomy had been performed.

Adolescent↗
PubMed1985

Role of sodium hyaluronate (Healonid) in triangular flap trabeculectomy.

The role of sodium hyaluronate (Healonid) in trabeculectomy to prevent a shallow or flat anterior chamber and hypotonia in the immediate postoperative period is reported. Twenty-nine eyes of 27 patients were included in a randomised controlled study. Thirteen eyes had trabeculectomy alone, and 16 eyes had trabeculectomy performed with Healonid injected into the anterior chamber. The results showed that shallowing of the anterior chamber and hypotonia occurred in both groups until day 21 postoperatively. There was no statistically significant difference between the two groups (p greater than 0.05). Healonid has no significant value in maintaining anterior chamber depth and preventing hypotonia in the early postoperative period following trabeculectomy.

Aged↗
PubMed1983

Earlier trabeculectomy.

This is a preliminary report of a collaborative, prospective, randomised trial of management of primary open angle glaucoma where conventional management using medical therapy followed by trabeculectomy only in unsuccessful cases (Group A) was compared with trabeculectomy as the primary form of treatment supplemented where necessary by medical therapy (Group B). Using one eye of each patient 40 eyes were available at one year and 14 eyes at two years after entry to the trial. The two groups were comparable for age, sex, intraocular pressure before treatment, visual acuity, visual fields and other features. Seven of the 22 eyes in Group A (31 per cent) had required operation in the first year and two of the 18 eyes in Group B (11 per cent) had required supplementary medical therapy in the same period. Trabeculectomy was more effective in lowering intraocular pressure than medical treatment. No statistically significant differences in visual function or disc appearances are yet detectable but there is a trend in favour of trabeculectomy as a primary procedure (Group B).

Aged↗
PubMed1980

A prospective, controlled study to compare the Scheie procedure with Watson's trabeculectomy.

Decisions regarding patient care are made difficult because of lack of adequate knowledge. Surgeons try to decide upon choice of procedure and surgical technique based on the results of their experience and their understanding of published reports. Yet there are virtually no prospective controlled studies comparing different procedures for open-angle glaucoma. The present study compares peripheral iridectomy with a thermal sclerostomy, as described by Scheie, with trabeculectomy, as described by Watson. In 15 patients with primary open-angle glaucoma a Scheie procedure was performed in one eye and a trabeculectomy in the other, the choice of procedure being determined randomly. Surgical technique was standardized. Shallow or flat anterior chambers were more common in patients treated with a Scheie procedure, but in the 15 cases studied no patients required alteration of their postoperative care because of any complication. When reevaluated five years later, central visual acuity was approximately the same in both groups, control of glaucomatous disease was considered to be slightly easier in patients receiving a Scheie procedure, and intraocular pressure was 16 mm Hg in patients treated with the Scheie procedure in contrast to 22 mm Hg in those in whom a trabeculectomy had been performed. The Scheie procedure resulted in a thin cystic conjunctival bleb. In only two cases was a detectable bleb present following trabeculectomy.

Cataract↗
PubMed1980

Outpatient trabeculectomy.

Eighty trabeculectomies were performed for medically uncontrolled adult phakic primary open angle glaucoma during the past two years. Forty-eight of these trabeculectomies were performed as outpatients and thirty-two of these trabeculectomies were performed as inpatients. We compared the complication rates of inpatients and outpatients during the first two weeks post-op. The results of this study demonstrate that early ambulation and moderate activity did not adversely influence the rate of early postoperative complications following trabeculectomy.

Ambulatory Surgical Procedures↗
PubMed1977

Trabeculectomy with cautery.

Trabeculectomy with cautery was performed on 31 eyes of of 25 glaucoma patients uncontrolled on maximal medical therapy. The procedure was designed to combine the effectiveness of Scheie's thermal sclerostomy with the low incidence of complications associated with trabeculectomy. There was an 81 percent success rate overall and an 83 percent success rate in blacks. Average follow-up was 25 months. The average preoperative pressure was 29 mm Hg and the average postoperative pressure was 11 mm Hg. Immediate postoperative complications were minimal. The most serious long-term problem was the acceleration of lenticular changes. The procedure is technically simple with a majority of cases being performed by house staff at a relatively early stage of training. It is believed that trabeculectomy with cautery is indicated in blacks, in far-advanced glaucoma cases, and in patients in whom a conventional trabeculectomy has failed.

Aged↗
PubMed1998

Aqueous humor uric acid and ascorbic acid concentrations and outcome of trabeculectomy.

OBJECTIVE: To determine if there is an association between the surgical outcome of trabeculectomy and uric acid and ascorbic acid concentrations in the aqueous humor at the time of the procedure. PATIENTS, MATERIALS, AND METHODS: Aqueous humor samples were collected from the eyes of 169 of 249 adult patients who underwent trabeculectomy alone for any type of glaucoma between April 1989 and July 1995. Postoperatively, all medical records were reviewed and outcomes were classified as successful, unsuccessful, or indeterminate. The ascorbic acid and uric acid concentrations were determined in masked fashion by high-pressure liquid chromatography. Factors associated with surgical outcome were determined. RESULTS: Uric acid concentration was higher in unsuccessful eyes (mean+/-SD, 0.21+/-0.08 mmol/L, n=26) than in successful eyes (0.15+/-0.09 mmol/L, n=91, 95% confidence interval for difference, 0.02-0.10 mmol/L). Ascorbic acid levels were not significantly different in the eyes with unsuccessful (1129.9+/-601.9 micromol/L) and successful (1334.3+/-511.0 micromol/L) surgery (95% confidence interval for difference, -475.2 to 66.4 micromol/L, P=.13) surgery. Other factors associated with failure were previous surgery and surgery performed at the inferior limbus. A multiple polytomous logistic regression analysis was performed, after excluding the small number of operations performed at the inferior limbus. The odds ratio for failure increased by a factor of 1.68 for every 1-mmol/L increase in uric acid (95% confidence interval, 1.16-2.43, P=.006). CONCLUSIONS: Uric acid levels were higher at the time of surgery in eyes that had unsuccessful outcomes than in those with successful outcomes. No significant difference in ascorbic acid levels was detectable. A higher uric acid level in the aqueous humor is a risk factor for trabeculectomy failure and might be tested as a prognostic indicator [corrected].

Aged↗
PubMed2000

Postoperative application of mitomycin for trabeculectomies.

BACKGROUND: Persistent hypotony is a severe complication following trabeculectomy with intraoperative application of mitomycin. OBJECTIVE: To reduce this rate of hypotony by using a lower concentration of mitomycin and applying the mitomycin only topically to the filtering bleb following surgery. METHODS: Patients were enrolled on a consecutive basis and prospectively followed up. Standard trabeculectomies were performed and mitomycin applied postoperatively on the 3 days following surgery (group 1). For comparison, data from previous studies were used for control eyes with intraoperative mitomycin application (group 2) and no mitomycin application (group 3). Preoperative and postoperative data, complications, and the need for further surgical procedures were evaluated. RESULTS: The study group (group 1) consisted of 22 cases. The mean follow-up was 13.4 and 13.5 months for groups 1 and 2, respectively. Average intraocular pressure values decreased from 33. 6 and 31.0 mm Hg (P =.32; t test) to 16.0 and 12.5 mm Hg in the 2 groups (P =.03; t test). The average number of medications decreased from 2.5 and 2.5 to 0.6 and 0.4 (P =.35; t test) in groups 1 and 2, respectively, at the last visit. Hypotony lasting for more than 3 months occurred only in eyes with intraoperative mitomycin application (14/22). Choroidal detachment (3/22) and hypotony maculopathy (2/22) also were only noted in eyes from group 2. In group 3, success rates were much lower. CONCLUSIONS: This is the first clinical study, to our knowledge, to evaluate the efficacy of this new technique of mitomycin application. From the results, it appears that the postoperative application of mitomycin following trabeculectomy is associated with a lower risk of severe and long-standing hypotony. This technique may be promising in eyes at low risk for failure.

Adolescent↗
PubMed2000

Effect of phacoemulsification surgery on hypotony following trabeculectomy surgery.

OBJECTIVE: To review the effect of phacoemulsification surgery in eyes with chronic hypotony following trabeculectomy with mitomycin C. DESIGN: Retrospective analysis of all eyes that underwent phacoemulsification surgery for symptomatic cataracts and had a preoperative diagnosis of chronic hypotony (intraocular pressure [IOP] </=6 mm Hg) for at least 6 months following trabeculectomy with mitomycin C. Each case had at least 6 months' follow-up after the phacoemulsification surgery. SETTING: A tertiary care referral center. INTERVENTION: Clear cornea phacoemulsification surgery, with minimal perioperative anti-inflammatory medication and retention of viscoelastic in eyes at case conclusion. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, and complications. RESULTS: Nine eyes of 9 patients were identified. Mean preoperative IOP was 4. 2 +/- 1.4 mm Hg; the mean postoperative IOP was 7.3 +/- 2.8 mm Hg (P=.009). Intraocular pressure increased in all but 2 eyes. One of these 2 eyes experienced an acutely elevated IOP (34 mm Hg) on postoperative day 4, which dropped back to preoperative levels after trabeculectomy flap needling. Mean preoperative visual acuity was 20/300; mean postoperative visual acuity was 20/40. CONCLUSION: Phacoemulsification surgery may be associated with a statistically significant elevation in IOP in previously filtered eyes with hypotony, resulting in resolution of hypotony in some of these challenging cases. Arch Ophthalmol. 2000;118:763-765

Aged↗
PubMed2002

Photodynamic therapy to control fibrosis in human glaucomatous eyes after trabeculectomy: a clinical pilot study.

OBJECTIVE: To evaluate the safety, tolerability, and clinical effect on intraocular pressure (IOP) of a carboxyfluorescein ester as an adjunctive antifibrotic therapy in human glaucomatous eyes to control postoperative wound healing after trabeculectomy. METHODS: In 10 human glaucomatous eyes with high IOPs that underwent 1 to 3 previous surgical procedures for glaucoma, 2'7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester was applied 15 minutes prior to trabeculectomy via a subconjunctival injection followed by intraoperative illumination with diffuse blue light (450-490 nm; approximately 51.9 x 10(3) candelas/m(2)) for 8 minutes. Antifibrotic efficacy was established by clinical response, postoperative IOP reduction, slitlamp examination, and filtering bleb site photographs. Success was defined as an IOP less than 21 mm Hg from baseline without the eye receiving any antiglaucomatous medication or an application of antimetabolites. RESULTS: The mean (SD) IOP on the day before surgery was 37.2 (11.2) mm Hg. The IOP was 16.6 (3.8) mm Hg in 8 successful eyes after a mean (SD) follow-up of 400.1 (38.1) days (P<.001). Two eyes showed scarring at the site of the filtering bleb within 1 month. In 1 eye with pseudoexfoliation glaucoma IOP decreased to 17 mm Hg but needed topical antiglaucomatous medication. Clinical examination revealed none of the following: blebitis, uveitis, endophthalmitis, or toxic damage of the adjacent tissues. CONCLUSIONS: We report our findings about the first 10 consecutive human glaucomatous eyes treated with a single dose of 80 microg of 2'7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester during trabeculectomy. In contrast to chemotherapeutic agents, cellular photoablation acts only on cells having incorporated 2'7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester and having been exposed to light of an appropriate wavelength. Though safety and efficacy demand a controlled randomized study, our method seems to be an effective therapeutic approach to control postoperative fibrosis in human glaucomatous eyes with a poor surgical prognosis. Multiple factors such as dose of light, means of application, wavelength, irradiation area, total dose of the dye, and multiple dosing may be altered in the future to improve the antifibrotic effect of photodynamic therapy during surgery for glaucoma.

Adolescent↗
PubMed2006

Effect of trabeculectomy on lens opacities in an East Asian population.

OBJECTIVE: To examine the progression of lens opacity in Asian people after trabeculectomy and determine associated risk factors. METHODS: This was an observational case series of 243 people aged 36 to 82 years. Trabeculectomy was performed on 1 eye of each subject. Lens opacity was measured yearly using the Lens Opacification Classification System III. The main outcome measure was worsening of lens opacity defined as an increase of 2 or more Lens Opacification Classification System III units in any of the 3 lens regions, nuclear, cortical, and posterior subcapsular. Risk of progression was evaluated using logistic regression models. RESULTS: Data for 177 people were analyzed. One hundred seventeen (66%) of 177 subjects showed progression in opacity in any lens region at 3 years. Seventy-seven (66%) of 117 of those who progressed did so during the first year. Of these, 63 (82%) of 77 had lens opacity in the posterior subcapsular region. Factors associated with progression of posterior-subcapsular lens opacity at 1 year were diabetes (odds ratio, 2.4; 95% confidence interval, 1.0-5.4), use of antiglaucoma medication, dosage of topical steroid postoperatively, and being operated on by a trainee surgeon (odds ratio, 2.3; 95% confidence interval, 1.0-5.2). CONCLUSIONS: Trabeculectomy is associated with progression of lens opacity predominantly in the posterior subcapsular region. Modification of risk factors such as postoperative steroid use may delay progression.

Adult↗
PubMed1990

Iris melanoma seeding through a trabeculectomy site.

A 59-year-old man who had previously undergone a trabeculectomy in his right eye was examined because of an enlarging pigmented lesion of the inferior portion of the iris. A fine-needle aspiration biopsy of aqueous fluid revealed spindle cells and epithelioid malignant melanoma cells. The eye was enucleated, and subsequent histopathologic examination demonstrated a mixed spindle cell and epithelioid cell melanoma of the inferior portion of the iris with seeding of melanoma cells into the conjunctival filtering bleb via the trabeculectomy site. This case illustrates the usefulness of fine-needle aspiration biopsy in the evaluation of pigmented iris lesions and illustrates that iris melanoma can seed through a trabeculectomy site.

Aqueous Humor↗