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PubMed1995

Effect of mitomycin C and fluorouracil-supplemented trabeculectomies on the anterior segment.

OBJECTIVES: To determine whether there is increased risk to the corneal endothelium when mitomycin C is used in trabeculectomy surgery instead of fluorouracil, and whether these agents play a role in accelerating cataract formation. DESIGN, SETTINGS, AND PARTICIPANTS: We analyzed the corneal endothelium and the lens preoperatively and postoperatively in 30 eyes of 21 patients who underwent either a fluorouracil- or mitomycin C-supplemented trabeculectomy. RESULTS: No significant differences were found between these two groups in the rate of cataract progression, magnitude of endothelial cell loss, or appearance of endothelial cell morphologic characteristics. Endothelial cell loss accounted for approximately 7% to 8% of the preoperative counts in both groups. In addition, four (27%) of 15 eyes in each group showed evidence of cataract progression as graded by the Lens Opacities Classification System II. CONCLUSION: Fluorouracil- and mitomycin C-supplemented trabeculectomies cause similar changes in the lens and corneal endothelium.

Aged↗
PubMed1996

Trabeculectomy at the inferior limbus.

OBJECTIVE: To evaluate intraocular pressure (IOP) control and surgical complications following trabeculectomy with 5-fluorouracil (5-FU) or mitomycin at the inferior limbus. METHODS: The charts of all patients undergoing trabeculectomy at the inferior limbus from July 1984 to March 1993 were reviewed. Surgical success was defined as IOP greater than 4 mm Hg and less than 22 mm Hg and at least a 20% reduction from preoperative IOP. PATIENTS: All 101 eyes of 101 patients had undergone prior intraocular surgery at the superior limbus. Mean patient age was 57.5 +/- 2.0 (+/-SE) years; mean follow-up was 23.4+/-2.3 months; mean preoperative IOP was 32.8+/-0.9 mm Hg; and mean number of preoperative antiglaucoma medications was 2.8+/-0.1. RESULTS: Ninety-four eyes (93.1%) received postoperative 5-FU (mean total dose, 36.3+/-1.7 mg) and seven eyes (6.9%) received intraoperative mitomycin (0.5 mg/mL). Cumulative success for all eyes at 2 and 5 years was 56% and 38%, respectively. Intraocular pressure control without medications was achieved in 39% and 15% of eyes at 2 and 5 years, respectively. Complications included 5-FU epitheliopathy (34.0% of eyes receiving 5-FU), early wound leak (26.7%), choroidal effusion (25.7%), late bleb leak (12.9%), and late bleb-related endophthalmitis (11.9%). CONCLUSION: Although trabeculectomy at the inferior limbus offers the opportunity for surgical success in eyes at high risk of failure, this procedure carries an increased risk for late complications and should be reserved for cases in which the therapeutic options are extremely limited.

Adolescent↗
PubMed2004

Needling for encapsulated trabeculectomy filtering blebs.

BACKGROUND: Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been suggested that needling of an encapsulated bleb may be effective in re-establishing drainage and lowering intraocular pressure. OBJECTIVES: The objective of this review is to assess the effects of needling encapsulated blebs on intraocular pressure. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library (Issue 2 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to May 2003) and LILACS (Latin American and Caribbean Health Sciences ) (June 2003). There were no language or date restrictions in the searches. SELECTION CRITERIA: We included randomised and quasi-randomised in which bleb needling was compared with any form of antiglaucoma medication in people with encapsulated trabeculectomy blebs. The primary outcome was mean intraocular pressure measured in millimetres of mercury at day one, one week, one month and at last available follow-up. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: One trial, which randomised 25 eyes to either needling or medical treatment, met the inclusion criteria. At one day post-treatment, mean intraocular pressure was lower in the needling group (16.28 mm Hg, standard deviation 5.9) than the medical group (19.45 mm Hg, standard deviation 3.75). The difference was not statistically significant. At all other follow-up points, mean intraocular pressure was consistently higher in the needling group than the medical group, although the differences were not statistically significant. However, only one needled bleb remained successful at the end of follow-up compared to 10 out of the 11 blebs managed conservatively. This difference was statistically highly significant. REVIEWERS' CONCLUSIONS: Evidence from one small trial suggests that needling of encapsulated trabeculectomy blebs is not better than medical treatment in reducing intraocular pressure.

Blister↗
PubMed1992

Induced astigmatism following small incision cataract surgery combined with trabeculectomy.

The combination of phacoemulsification and implantation of foldable intraocular lenses through a small incision with a trabeculectomy is increasingly preferred in glaucoma patients with coexisting cataract. Small incisions induce less astigmatism and thereby enhance visual recovery. This study should clarify if this benefit of small incision cataract surgery is preserved when combined with a trabeculectomy. Thirty-five eyes were included in this study. Preoperative astigmatism measurements were compared with those obtained one month and one year postoperatively. Vector analysis was performed. A series of 30 cases which underwent small incision cataract surgery alone were used as a control group. One month postoperatively the eyes undergoing the combined procedure showed about the same with-the-rule astigmatic peak (mean: +0.32 dpt.) as the control group eyes (mean: +0.26 dpt.; p > 0.05). One year postoperatively both groups showed the same against-the-rule astigmatic shift (mean: -0.28 dpt.; p > 0.05). In conclusion, patients undergoing small incision cataract surgery combined with trabeculectomy showed a small amount of surgically induced astigmatism. When compared with patients which underwent small incision cataract surgery alone, the difference in astigmatic changes was found to be statistically not significant.

Astigmatism↗
PubMed1996

Histopathology of episcleral fibrosis after trabeculectomy with and without mitomycin C.

BACKGROUND: The aim of the study was to investigate the histopathologic features of scar tissue which have proliferated at the site of trabeculectomy of surgical failures after procedures with and without the use of the antimetabolite mitomycin C (MMC). METHODS: We obtained seven surgical specimens after trabeculectomy without MMC and five specimens after trabeculectomy with MMC, which were compared with 23 controls. Sections were stained with hematoxylin and eosin, Verhoeff-van Gieson, Grocott methenamine silver, and alcian blue. An immunohistochemical stain was performed for alpha-smooth muscle actin. RESULTS: Specimens from eyes operated without MMC showed dense scar tissue with many fibroblasts, much ground substance, parallel-oriented collagen fibers, and contractile intracellular proteins within the fibroblasts. Specimens from eyes operated with MMC consisted of tissue with only few fibroblasts which did not exhibit contractile proteins. Collagen fibers were arranged randomly with less ground substance. CONCLUSION: Even after 1-10 months, the scar tissue was distinctly different in the two groups. These results suggest that the use of MMC has long-term effects in vivo. Surgical failures related to scar formation are possible and not reduced to zero.

Actins↗
PubMed1988

Raised intraocular pressure with topical steroids after trabeculectomy.

A prospective study of 87 eyes of 52 patients with primary open-angle glaucoma showed a significant steroid-induced rise in intraocular pressure in the 4 weeks after trabeculectomy in 23% of eyes. The steroid response rate was lower (17%) in those eyes that had trabeculectomy without a prior trial of medical therapy than in those who had surgery only after failure of medical therapy (36%), but this difference just failed to reach statistical significance. The responders were not significantly different from the non-responders as regards level of intraocular pressure or severity of visual field loss at diagnosis. The frequency of response was lower than that expected in the normal and in the glaucoma population and fell further in the late post-operative period when only 3 of 8 previously responsive eyes submitted to re-challenge with topical steroids showed persisting responsiveness. Topical steroids may be the commonest cause of high intraocular pressure in the first weeks or even days after trabeculectomy. Decisions about long-term supplementary medical therapy should therefore only be taken several weeks after withdrawal of the post-operative steroid drops.

Betamethasone↗
PubMed2001

[Follow-up of trabeculectomy. Complications and therapeutic consequences].

BACKGROUND: Intensive follow-up after trabeculectomy is important for long-term success. In the postoperative period, complications must be detected early in order to initiate adequate therapeutic measures. PATIENTS AND METHODS: In a retrospective study 113 eyes from 113 consecutive patients were followed-up for a period of 6 months after trabeculectomy with regard to postoperative complications and therapeutic decisions (invasive and conservative). Criteria of success were defined as an intraocular pressure (IOP) < 21 mmHg without antiglaucomatous treatment as well as an IOP reduction > 20% compared to the preoperatively treated IOP. RESULTS: Most of the postoperative complications occurred within the first 3 weeks: scarring of the filtering bleb (47.6%), choroidal detachment (18.6%), shallowing of the anterior chamber (8%), fibrinous reaction (5.3%), overfiltration (4.4%), reduced flow under the scleral flap (4.4%), corneal dellen (3.5%), prolapse of the iris (3.5%), external fistulation (2.7%), increase of the IOP due to steroids (1.8%), detachment of the ciliary body (1.8%) and malignant glaucoma (0.9%). In the postoperative period, 45.1% of the eyes needed further interventions such as 5-fluorouracil (5-FU) injections (28.3%), needling and 5-FU-injections (14.2%), laser suturolysis (6.2%). Repositioning of the iris, YAG-laser iridotomy, laser treatment of the filtering bleb, autologous blood injection and cyclocryoapplication were needed only in rare cases and 36.3% received other conservative treatment (i.e. modification of topical steroids, increase of cycloplegic treatment). After 6 months the success rate without antiglaucoma medication was 88.5%. CONCLUSIONS: An intensive follow-up after trabeculectomy is mandatory to avoid postoperative failure. In about half of the patients postoperative additional therapeutic measures became necessary, particularly if scarring of the filtering bleb occurred. Paying attention to these factors yields in a high success rate after filtering surgery.

Adult↗
PubMed2003

Endoscopically controlled erbium:YAG goniopuncture versus trabeculectomy: effect on intraocular pressure in combination with cataract surgery.

PURPOSE: . To compare the efficacy of endoscopic erbium:YAG laser goniopuncture in glaucoma treatment to trabeculectomy, both methods as adjuncts to cataract surgery. METHODS: . Fifty-nine eyes of 59 glaucoma patients with coexistent cataract were treated by phacoemulsification and endoscopic Er:YAG goniopuncture in a combined fashion. The primary study endpoints were intraocular pressure (IOP), number of antiglaucomatous drugs, postoperative complications, hospitalisation time and visual acuity at 1 year after surgery. To date, 24 eyes have finished the 1-year follow-up. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by trabeculectomy and cataract surgery in a single procedure. RESULTS: . In the laser-treated group, the mean IOP dropped by 30% from 23.4+/-3.7 mmHg to 16.3+/-6 mmHg ( P<0.0001) after 12 months. Without reoperation, treatment was successful in 71% of these eyes. In the control group, the IOP decreased by 33.5% from 22.7+/-3.3 mmHg to 15.1+/-3.8 mmHg ( P<0.0001). The success rate without reoperation was 46%. The number of antiglaucomatous drugs needed decreased from 1.48+/-0.95 to 0.48+/-0.7 ( P<0.0001) in the laser-treated group and from 2.0+/-0.9 to 0.39+/-0.6 ( P<0.0001) in the control group. Postoperative complications were found more frequently in the control group ( P<0.0001). Hospitalisation was shorter in the laser group ( P<0.0001). Postoperative visual acuity was lower in the control group ( P=0.004). CONCLUSION: . Combined Er:YAG goniopuncture and cataract surgery lowers the IOP to an extent comparable to combined trabeculectomy and cataract surgery. Due to fewer postoperative complications, Er:YAG goniopuncture seems to be superior to standard fistulation surgery as the primary approach within the first year.

Aged↗
PubMed2005

Combined cataract and glaucoma surgery: endoscope-controlled erbium:YAG-laser goniotomy versus trabeculectomy.

BACKGROUND: To compare endoscopic infrared laser trabecular ablation and trabeculectomy (both combined with cataract surgery) regarding intraocular pressure (IOP), visual acuity, anti-glaucomatous drugs and complications. METHODS: Seventeen eyes of 14 patients [age 74.7+/-11.7 years (arithmetic mean +/- standard deviation)]-13 with primary open-angle glaucoma (POAG) and four with pseudoexfoliation glaucoma (PEXG)-underwent standard cataract surgery. After lens implantation, a probe (1.1 mm external diameter) with optic and laser fibres and an irrigation tube was introduced through the cataract incision. To perforate Schlemm's canal, 15-17 single pulses (16 mJ, 160 micros) were applied using a photo-ablative infrared laser (Er:YAG, lambda=2.94 microm). All eyes except one received antiglaucoma treatment. The control group treated with cataract surgery and trabeculectomy consisted of 17 eyes (13 POAG, four PEXG) of 15 patients (age 75.0+/-5.6 years), each eye received antiglaucoma treatment. RESULTS: Mean follow-up was 3 years. The eyes treated with the endoscopic laser showed a mean preoperative IOP of 23.3+/-4.3 mmHg, which was reduced to 15.0+/-2.1 mmHg (mean IOP lowering 33.7%) after 3 years. Five eyes needed no medication for IOP-control after the procedure. Two eyes needed further surgery for IOP-control. In the control group, mean IOP was 24.5+/-2.6 mmHg in the beginning and 17.3+/-6.2 mmHg after 3 years, corresponding to a 33.3% lowering of IOP. Six eyes needed no medication, four eyes needed further surgery to lower IOP. CONCLUSIONS: After 3 years follow-up of a small pilot group, combined endoscopic infrared laser surgery with cataract surgery seems to be a safe and effective way to lower IOP. It shows the same ability to lower IOP as combined cataract surgery with trabeculectomy. In addition, there are markedly less complications with the endoscope-controlled photo-ablative laser procedure.

Aged↗
PubMed1998

Conditions for balance between lower normal pressure control and hypotony in mitomycin trabeculectomy.

BACKGROUND: Striving for low to ultra-low postoperative intraocular pressure (IOP) through filtering surgery usually increases the incidence of prolonged hypotony. Early postoperative prognostic indicators for IOP control to lower normal level and prolonged hypotony in trabeculectomy with mitomycin C were examined to determine conditions required to obtain an optimum balance between them. METHODS: Records of initial trabeculectomy with mitomycin C (0.4 mg/ml, 3 min) in 59 consecutively operated Japanese patients with primary open-angle glaucoma who had used multiple medications before operation were retrospectively analyzed. IOP control to lower normal level was defined as having failed if IOP could not be maintained below 15 mm Hg without medication. Prolonged hypotony was defined as postoperative IOP below 5 mm Hg for more than 2 months, excluding the first month. The Cox proportional hazards model was applied to identify early postoperative factors contributing to the two surgical outcomes. RESULTS: Among the factors studied, only the mean IOP on postoperative days 9-14 was significantly correlated with the surgical outcome. A receiver operating characteristic plot suggested that mean IOP of 8 mm Hg in this period would give an optimum balance between the two. CONCLUSION: IOP of 8 mm Hg 9-14 days after surgery may be advisable in patients with preoperative multiple medications in whom IOP control to lower normal level is attempted with mitomycin C trabeculectomy. Knowledge of this may be helpful in deciding when laser lysis of sutures is indicated.

Female↗
PubMed2000

The effect of mitomycin C trabeculectomy on the progression of visual field defect in normal-tension glaucoma.

BACKGROUND: We investigated in a prospective fashion the visual prognosis and complications in normal-tension glaucoma following unilateral trabeculectomy with adjunctive mitomycin C. METHODS: Trabeculectomy with adjunctive mitomycin C was carried out unilaterally in 21 cases of normal-tension glaucoma. Intraocular pressure (IOP), visual prognosis, and complications were compared between the operated eyes and the non-operated fellow eyes. The follow-up period ranged from 2 to 7 years. RESULTS: The IOP dropped significantly from 14.8+/-1.8 mmHg (mean +/- SD) to 9.6+/-3.9 mmHg in the operated eyes (P=0.0002, Wilcoxon signed-rank test), but did not drop in the non-operated eyes. The mean deviation (MD) was -12.69+/-6.41 dB preoperatively and -14.70+/-5.49 dB at the last clinic visit in the operated eyes, whereas in non-operated eyes it was -7.85+/-5.65 dB and -11.15+/-5.62 dB, respectively. The MD deteriorated significantly in both operated and non-operated eyes (operated eyes P=0.0239, non-operated eyes: P=0.0002; Wilcoxon signed-rank test). The MD slope was -0.37+/-0.60 dB/year and -0.71+/-0.89 dB/year for the operated and non-operated eyes, respectively (P=0.5243, Mann-Whitney U-test). Visual field deterioration was more frequently observed in the non-operated eyes by a pointwise definition of the progression (P<0.05, McNemar test). Visual acuity deteriorated in 6 of the operated eyes and in 5 of the non-operated eyes. Cataract developed in 6 (29%) of the 21 operated eyes, while among the non-operated eyes 4 (19%) developed cataract. CONCLUSION: Mitomycin C trabeculectomy is effective in delaying progression of visual field defect in normal-tension glaucoma, but complications may arise and cause some visual disturbance.

Adult↗
PubMed2001

Effect of cataract surgery on intraocular pressure in eyes with previous trabeculectomy.

PURPOSE: To determine the course of the intraocular pressure in eyes in which cataract surgery was performed after trabeculectomy. METHODS: This was a retrospective study of consecutive patients who were scheduled for routine cataract surgery. The patients had previously undergone glaucoma filtering surgery. Pre- and postoperative data were evaluated. Both the status of glaucoma and the increase in visual acuity were monitored. RESULTS: Patients operated on over a six-year period were enrolled. The mean interval between glaucoma surgery and cataract surgery was 58.1 months. The mean duration of follow-up after cataract surgery was 31.4 months, with a minimum of 12 months. The mean central visual acuity increased by 4 lines. Before cataract surgery, 53% of the eyes had complete success (group 1), while 28% had qualified success (group 2) and the remaining 19% were failures (group 3). From group 1, 61% remained a complete success until the last visit. No eye of group 1 developed a failure. In group 2, 23% were a complete success at the final follow-up, while 4% failed. In group 3, only 35% were failures while the remaining 65% were a complete or qualified success. CONCLUSIONS: Eyes with a well-controlled intraocular pressure following trabeculectomy seem to have a favorable prognosis after subsequent cataract surgery. Eyes with qualified success or failure before cataract surgery have a slight chance of improvement in intraocular pressure control. Cataract surgery had no markedly negative effect on the intraocular pressure overall. Performing trabeculectomy and cataract surgery at different times may still be a feasible option as opposed to combined procedures.

Adult↗
PubMedDate not supplied

Efficacy and complications after trabeculectomy with mitomycin C in normal-tension glaucoma.

PURPOSE: To evaluate the efficacy of and complications after trabeculectomy using mitomycin C (MMC) in Japanese normal-tension glaucoma (NTG) patients by a retrospective analysis based on the Kaplan-Meier life table method. METHODS: Clinical records of 39 NTG patients who underwent trabeculectomy with 0.04% MMC and had postoperative follow-up periods of 3 years or more (50.5 +/- 8.4 months, mean +/- SD) were reviewed. Postoperative intraocular pressure (IOP) at every 1 or 2 months, complications, visual acuity, and visual field at every 6 months were recorded. RESULTS: IOP significantly decreased from 15.9 +/- 1.9 preoperatively to 8-11 mmHg throughout the postoperative follow-up period (P < 0.0001). The life table analysis, in which failure of IOP control was defined as an IOP above a level either 30% or 20% lower than the preoperative IOP at three consecutive visits, showed a cumulative survival rate of 39.4 +/- 7.8% (mean +/- SEM) or 41.3 +/- 8.9%, respectively, at 4 years after surgery. Mean deviation of the visual field results did not significantly change (P > 0.5). The cumulative survival rate from postoperative late-onset hypotony was 74.7 +/- 6.3% at 4 years after surgery. Postoperative complications observed were shallow anterior chamber (six eyes), choroidal detachment (nine eyes), hypotonous maculopathy (seven eyes), bleb leak (one eye), cataract development (three eyes), and blebitis (two eyes). No eyes developed endophthalmitis. CONCLUSIONS: In NTG patients, trabeculectomy with MMC showed significant efficacy in reducing IOP up to 4 years after surgery. Since risks of postoperative complications are unavoidable, indications for surgery should be carefully considered, and careful follow-up is necessary to avoid severe postoperative complications.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

The outcome of mitomycin C trabeculectomy and laser suture lysis depends on postoperative management.

PURPOSE: To verify that postoperative management affects the outcome of mitomycin C (MMC) trabeculectomy and suture lysis. METHODS: A total of 108 eyes in 108 Japanese patients were treated with MMC trabeculectomy. They were divided into two groups based on when the operation was performed: group A, 57 eyes in 1998, and group B, 51 eyes in 2001. The results, including postoperative intraocular pressure (IOP), complications, and postoperative management, were compared between groups. In addition, they were evaluated by a Kaplan-Meier life-table analysis. RESULTS: Postoperative IOP was lower and the probability of success by life-table analysis was higher in group B than in group A. Postoperative management, including laser suture lysis and subconjunctival injection of 5-fluorouracil, was started significantly earlier in group B than in group A patients. Although more postoperative complications occurred in group B, none were severe and all were adequately managed. CONCLUSIONS: Starting postoperative management earlier, particularly laser suture lysis, may be necessary to achieve lower and longer IOP control in MMC trabeculectomy.

Antibiotics, Antineoplastic↗
PubMed2005

Viscocanalostomy versus trabeculectomy in patients with bilateral high-tension glaucoma.

Results of trabeculectomy (TE) and viscocanalostomy (VCO) were compared in a prospective randomised study in two fellow eyes of 22 consecutive patients with bilateral symmetrical high-tension glaucoma. Rates of overall surgical success with intraocular pressures (IOP) < or = 18 mm Hg with or without medications were 91 for the TE, and 95 for the VCO group after a mean follow-up of 18 months. Complete success rates without medications were 64 and 59 for TE and VCO groups, respectively (p = 0.750). Both procedures significantly reduced IOP, however, IOP course following trabeculectomy was significantly lower (p = 0.026). Rates of complications were not found to be different between the two groups of eyes, except for an apparent--though not significant (p = 0.066)--increase in cataract progression with TE. Various types of conjunctival blebs were detected in all eyes with surgical success in both groups, however, diffuse, elevated or multi-cystic functional blebs appeared to be more predominant in eyes with TE, compared to the VCO group in which low-lying, localised blebs had a higher incidence (p = 0.015). Viscocanalostomy was found to be a safe and effective filtration technique in patients with uncomplicated high-tension glaucoma, though IOP decrease was more pronounced with trabeculectomy.

Adult↗
PubMed2006

Imaging of trabeculectomy blebs using anterior segment optical coherence tomography.

OBJECTIVE: To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT). DESIGN: Prospective cross-sectional study. PARTICIPANTS: Fifty-five patients who had previously undergone trabeculectomy surgery. METHODS: All blebs were imaged with a prototype of the AS-OCT. Standardized color monophotographs of blebs were also obtained. Blebs were assessed for the following qualitative features: bleb height, thickness of the conjunctiva in the bleb wall, presence of cystic spaces within the bleb wall, apposition of the scleral flap to underlying sclera, and patency of the internal ostium. MAIN OUTCOME MEASURES: For blebs with preoperative intraocular pressure (IOP) > 18 mmHg with or without ocular hypotensive medication, success was defined as last recorded IOP< or =18 mmHg without topical glaucoma medication. For blebs with preoperative IOP< or =18 mmHg with ocular hypotensive medication, success was defined last recorded IOP< or =18 mmHg with cessation of ocular hypotensive medication. For blebs with preoperative IOP< or =18 mmHg without ocular hypotensive medication, a 20% drop in IOP with no ocular hypotensive medication was accepted as success. RESULTS: Seventy-eight blebs in eyes of 55 patients were imaged. There were 32 (58.2%) men and the mean age was 68.9+/-11.5 years. Fifty-seven (73.1%) blebs were classified as successful. Anterior segment optical coherence tomography identified the following bleb characteristics: total bleb height, bleb cavity, bleb wall thickness, tangential and radial dimensions, scleral flap thickness, and patency of the internal ostium. The majority of successful blebs displayed thickening of the bleb wall. Failed blebs were mostly low and were characterized by ostial occlusion, apposition of conjunctiva-episclera to sclera or apposition of the scleral flap to its bed. Thickening of the bleb wall was typically absent. CONCLUSIONS: AS-OCT is a promising tool to image trabeculectomy blebs. It was able to demonstrate features of bleb morphology not visible with the slit lamp.

Aged↗
PubMed2000

Randomized, controlled study of low-dose 5-fluorouracil in primary trabeculectomy.

PURPOSE: To report a randomized clinical trial of postoperative subconjunctival injections of low-dose 5-fluorouracil in patients undergoing primary trabeculectomy. METHODS: In a prospective, randomized clinical trial, 40 eyes of 40 patients were randomized to the low-dose 5-fluorouracil group and received three subconjunctival injections of 5 mg each over 11 postoperative days, and 40 eyes of 40 patients were randomized to trabeculectomy without 5-fluorouracil. RESULTS: Mean (+/-SD) preoperative and 1-year postoperative intraocular pressures in the 5-fluorouracil group were 26.9 (+/-9.5) and 15.3 (+/-5.8) mm Hg, respectively. In the control group these were 25.9 (+/-8.1) mm Hg, and 15.8 (+/-5.1) mm Hg, respectively. The patients who received 5-fluorouracil had a mean reduction in intraocular pressure of 11.5 (+/-9.1) mm Hg at a median follow-up of 52.3 weeks. The control group had a mean reduction in intraocular pressure of 10.2 (+/-8.7) mm Hg at a median follow-up of 52.6 weeks. These differences were not statistically significant. CONCLUSIONS: Three postoperative subconjunctival 5-fluorouracil injections of 5 mg each after trabeculectomy in eyes at low risk for failure had no statistically or clinically significant effect on reduction of intraocular pressure with 1-year follow-up. Enhancement of success in this group of patients may require a larger total dose of 5-fluorouracil.

Adult↗
PubMed2002

Late-onset transconjunctival oozing and point leak of aqueous humor from filtering bleb after trabeculectomy.

PURPOSE: To estimate the prevalence and identify factors related to late-onset transconjunctival aqueous oozing and point leak from functioning blebs after trabeculectomy with 5-fluorouracil (5-FU) or mitomycin C. DESIGN: Cross-sectional study. METHODS SETTING: The study took place at the outpatient clinic of the Department of Ophthalmology, University of Tokyo Graduate School of Medicine (Tokyo, Japan). Four hundred three consecutive patients (403 eyes) with functional blebs at least 3 months after previously performed trabeculectomy were examined between December 1997 and February 1998. The Seidel test was performed with extended observation up to 15 seconds. Oozing was identified as transconjunctival aqueous egress without interruption of the conjunctival tissue or aqueous stream on the bleb wall. Logistic regression analyses of oozing and point leak in 331 eyes with an avascular area were performed using independent variables, including age, gender, glaucoma diagnosis, prior incisional surgery, antimetabolite use, combined cataract surgery, postoperative follow-up period, intraocular pressure (IOP), concurrent glaucoma therapy, bleb size, and avascular area size. RESULTS: Of 403 eyes, 48 eyes (11.9%) had oozing and 8 eyes (2.0%) had point leak. Intraocular pressure was significantly lower and an avascular area was more frequent in eyes with oozing or leak than in eyes without (P <.001). Logistic regression analysis revealed that oozing was significantly more common after use of 5-FU than mitomycin C (P =.024), whereas point leak was associated with a larger avascular area (P =.045). CONCLUSIONS: After trabeculectomy with antimetabolites, transconjunctival oozing is much more frequent than point leak. Oozing was significantly associated with the use of 5-FU and point leak with a larger avascular area in the bleb.

Antimetabolites↗