Intrableb triamcinolone acetonide injection after bleb-forming filtration surgery (trabeculectomy, phacotrabeculectomy, and trabeculectomy revision by needling): a pilot study.
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Adult↗
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Filtration and complications after trabeculectomy and after phaco-trabeculectomy.
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Aged↗
Further report on trabeculectomy "trabeculectomy with scleral flap".
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Female↗
Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified postoperative care (IPC).
PURPOSE: To define the success rate of trabeculectomy for surgical treatment of glaucoma under intensified postoperative care (IPC) conditions in cases of severe visual field damage or progression of visual field loss. METHODS: In a retrospective study, we evaluated the outcome of trabeculectomy in 99 eyes of 99 patients from October 1995 to June 1997. In 23 eyes, antimetabolites were used intraoperatively. Regarding intraocular pressure (IOP), success was defined as lowering the preoperative, maximally treated IOP by more than 20% in addition to a postoperative IOP level lower than 21 mmHg without using further glaucoma medication. Success rate was defined by stabilisation of visual acuity and visual field in addition to IOP reduction. RESULTS: The postoperative IOP was 14.7 mmHg (+/- 3.4 mmHg) following standard trabeculectomy (preoperative IOP 24.3 +/- 6.7 mmHg) and 15.8 mmHg (+/- 4.9 mmHg) following trabeculectomy with intraoperative antimetabolites (preoperative IOP 27.0 +/- 9.5 mmHg). The success rate concerning the IOP was 83% in standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. The visual acuity showed stabilisation in 93% of cases following standard trabeculectomy and in 100% following trabeculectomy with intraoperative antimetabolites. The visual field showed stabilisation according to the Aulhorn criteria in 95% and 94% of cases following standard trabeculectomy and trabeculectomy with intraoperative antimetabolites, respectively. The total success rate using all criteria together was 76% following standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. CONCLUSION: The overall outcome after trabeculectomy is good with appropriate follow-up and timely decisions for after-treatment to ensure good development of the filtering bleb.
Adult↗
Comparison of trabeculectomy with mitomycin C with or without phacoemulsification and lens implantation.
PURPOSE: To compare the results of combined trabeculectomy with phacoemulsification and posterior chamber intraocular lens (IOL) implantation to those of trabeculectomy alone using mitomycin C (MMC) application intraoperatively in all cases. PATIENTS AND METHODS: A retrospective comparative study of consecutive patients was conducted on two groups: 102 eyes of 90 patients studied in the combined procedure group, and 33 eyes of 30 patients in the trabeculectomy alone group. RESULTS: Both groups showed a significant decrease in IOP. The combined group had a change from 21.5+/-5.8 mm HG preoperative to 14.73+/-3.44 mm HG postoperative, P=0.0001; the trabeculectomy group changed from 24.2+/-7.5 mm HG preoperative to 12.46+/-3.86 mm HG postoperative, P=0.0001. This represents a 31.5% reduction in IOP in the combined group versus a 48.5% reduction in the trabeculectomy alone group (P=0.0001). The follow-up time was longer in the trabeculectomy group (trabeculectomy group, 22.6+/-13.3 months; combined group, 14.2+/-8.0 months), P=0.0014. There were 97 eyes in the combined group (95%) and 32 eyes (97%) in the trabeculectomy group that had an IOP of less than 20 mm HG at the end of follow up. Postoperatively, the two groups showed similar significant reductions in the number of antiglaucomatous medications used (combined group, 0.82+/-1.0 compared with 2.65+/-0.84 preoperatively, P=0.0001; trabeculectomy group, 0.76+/-1.2 compared with 2.7+/-0.95 preoperatively, P=0.0001). There were no cases of bleb leakage in the combined group and two cases (6%) in the trabeculectomy group. CONCLUSION: The reduction of IOP is significantly larger after trabeculectomy alone than after the combined procedure; however, the functional and anatomical results of the combined procedure of phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with MMC application were as good as those of trabeculectomy alone with MMC.
Adult↗
Temporal corneal phacoemulsification combined with superior trabeculectomy: a controlled study.
OBJECTIVE: To determine the intraocular pressure (IOP)-lowering effects of combined temporal corneal phacoemulsification and separate incision superior trabeculectomy with those of trabeculectomy alone. METHODS: This is a retrospective case-control study of 40 consecutive patients who underwent combined temporal corneal phacoemulsification and superior trabeculectomy with low-dose 5-fluorouracil (5-FU) (cases), and 40 eyes matched with respect to age, race, preoperative medications, and preoperative IOP that had trabeculectomy alone with low dose 5-FU (controls). Survival analyses for IOP were performed for the cases and controls. We reviewed the charts of 40 consecutive patients who underwent combined temporal corneal phacoemulsification and superior trabeculectomy with low dose 5-FU to determine the effect on IOP, visual acuity, and requirement for glaucoma medications. For controls, we chose 40 eyes matched with respect to age, race, preoperative medications, and preoperative IOP who had trabeculectomy alone with low dose 5-FU. In both groups, trabeculectomy was performed with the same technique, was located superiorly, and employed a limbus-based conjunctival flap. In the combined surgery group, temporal corneal phacoemulsification immediately preceded trabeculectomy and employed a 3.5-mm incision and a one-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-FU injections of 5 mg each over the first 11 postoperative days. Patients were followed up for at least 1 year. Success of trabeculectomy was defined as an IOP less than 22 mmHg and 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications. RESULTS: The mean postoperative intraocular pressure was higher in the combined surgery group than in the control group at each follow-up interval (P < 0.05). The mean (+/- SD) IOP reduction was 6.8 (+/- 5.5) mmHg in the combined surgery group, and 10.3 (+/- 7.6) mmHg in the trabeculectomy group at 1 year. The reduction in the number of antiglaucoma medications was 1.6 (+/- 0.9) in the combined surgery group and 2.0 (+/- 1.0) in the control group at 1 year. In the combined surgery group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < 0.001). Kaplan-Meier survival analysis showed that the cumulative success rate at 2 years was 62% in the combined surgery group and 86% in the trabeculectomy group. The time to failure was significantly shorter (P = 0.04) in the combined surgery group. CONCLUSIONS: Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone, despite identical trabeculectomy techniques in both groups. Nevertheless, combined surgery effectively lowers IOP and reduces the long-term requirement for antiglaucoma medications without additional complications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.
Aged↗
The efficacy and safety of intraoperative and/or postoperative 5-fluorouracil in trabeculectomy and phacotrabeculectomy.
PURPOSE: First, to assess the safety and efficacy of using 5-fluorouracil (5-FU) to improve trabeculectomy and phacotrabeculectomy success rates, and second, to assess the efficacy of intraoperative and reduced postoperative 5-FU following trabeculectomy compared with a more intensive course of postoperative 5-FU alone. METHODS: In a retrospective, unmatched, non-randomized consecutive series study, 186 eyes of 186 patients who had filtration surgery were followed for 2 years in four groups: 51 patients had undergone trabeculectomy surgery with postoperative 5-FU, 51 had phacotrabeculectomy with postoperative 5-FU, 56 had trabeculectomy with both intraoperative and postoperative 5-FU, and 28 patients had trabeculectomy without antifibrotics. RESULTS: At all times mean intraocular pressure (IOP) was reduced n all groups (P < 0.001 for each group). Success was defined as IOP < 16 mmHg and > 30% IOP reduction at the 2-year follow up. It was achieved in 71% of the trabeculectomy patients with intraoperative and postoperative 5-FU, 76% of the trabeculectomy group with only postoperative 5-FU, 55% of the phacotrabeculectomy/5-FU group, and in 29% of the trabeculectomy-only eyes (between-group differences P < 0.01). Success rates were not significantly different for the intraoperative and postoperative 5-FU trabeculectomy versus the postoperative 5-FU-only eyes, but the former had fewer postoperative 5-FU injections and corneal ulceration (P < 0.01 for both). CONCLUSIONS: 5-Fluorouracil was safe and improved trabeculectomy survival. Intraoperative 5-FU allowed fewer postoperative 5-FU injections and fewer side-effects without compromising success rates. Phacotrabeculectomy with postoperative 5-FU had a lower surgical success rate than did trabeculectomy with 5-FU and this was not statistically different from trabeculectomy without 5-FU.
Adolescent↗
The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy.
OBJECTIVES: To compare the risk of cataract formation in eyes with and without prior trabeculectomy and to assess other risk factors for cataract. METHODS: The Advanced Glaucoma Intervention Study (AGIS) has been following 789 eyes in 591 patients with medically uncontrolled open-angle glaucoma. From 1988 to 1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or a trabeculectomy-ALT-trabeculectomy sequence. Cox regression analyses were used to assess risk factors for cataract formation during 7 to 11 years of follow-up. MAIN OUTCOME MEASURES: Cataract, defined as either having had cataract surgery or confirmed severe lens opacity with a best-corrected Early Treatment Diabetic Retinopathy Study visual acuity score less than 65 letters (worse than 20/50). RESULTS: Data are presented on the expected 5-year cumulative probability of cataract formation in each randomized sequence by age and presence of diabetes at study entry. Overall, approximately half of the eyes studied developed cataract. A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio [RR] = 1.78; P<.001). Diabetes (RR = 1.47; P =.004) and age at study entry (RR = 1.07 per year of age; P<.001) were also risk factors for cataract. When postoperative complications of trabeculectomy were included in the analysis, the increased risk of cataract for eyes with a first trabeculectomy reduced to 47% when complications did not occur (RR = 1.47; P =.003) and increased to 104% when complications did occur (RR = 2.04; P<.001). Several specific postoperative complications of trabeculectomy were associated with increased risk of cataract, particularly marked inflammation (RR = 3.29; P<.001) and flat anterior chamber (RR = 1.80; P =.004). Trabeculectomy with complications was also significantly associated with an increased risk of cataract in each of 3 lens regions: nuclear, cortical, and posterior subcapsular. CONCLUSIONS: In eyes of AGIS patients, after adjustment for age and diabetes, trabeculectomy increased the risk of cataract formation by 78%.
Adult↗
The National Survey of Trabeculectomy. III. Early and late complications.
PURPOSE: There is a considerable body of literature relating to trabeculectomy, however there are no data representative of the national experience of trabeculectomy in the United Kingdom (UK). The Department of Health funded a national survey of trabeculectomy to establish current practice patterns and the outcome of trabeculectomy in the National Health Service (NHS). In this paper we present the reported complications of first-time trabeculectomy from a nationally representative cohort of patients with chronic open angle glaucoma. METHODS: Cross-sectional study of consultant ophthalmologists performing trabeculectomy in the NHS. Participants recruited their four most recent consecutive first-time trabeculectomy cases with chronic open angle glaucoma according to study eligibility criteria and data were collected by self-administered questionnaire. FOLLOW-UP: one year post-trabeculectomy. MAIN OUTCOME MEASURES: occurrence of early and late complications. RESULTS: Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n = 304, 24.6%), shallow anterior chamber (n = 296, 23.9%), hypotony (n = 296, 24.3%), wound leak (n = 216, 17.8%) and choroidal detachment (n = 175, 14.1%). The most frequent late complications were cataract (n = 251, 20.2%), visual loss (n = 230, 18.8%) and encapsulated bleb (n = 42, 3.4%). The occurrence of most complications was not associated with a consultant's specialist interest, level of activity, type of hospital or region. Encapsulated bleb was reported more frequently in a university hospital setting. CONCLUSIONS: The complication rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. These are similar to previous published studies and highlight in particular, the impact of trabeculectomy on visual acuity in the first year following surgery. This survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level.
Anterior Chamber↗
Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery.
PURPOSE: To evaluate the safety and efficacy of trabeculectomy with or without mitomycin-C (MMC) in the management of glaucoma in aphakia and pseudophakia following congenital cataract surgery. PATIENTS AND METHODS: All patients of glaucoma with aphakia or pseudophakia who underwent trabeculectomy with or without MMC from January 1989 to April 2000 were included. The medical records of 19 consecutive patients (23 eyes) were reviewed. Data collected from a retrospective chart review were analysed. Outcome measures were evaluated using Kaplan-Meier survival analysis. Pre- and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, surgical failure and complications were the main outcome measures. Successful IOP control was defined as an IOP between 6 and 21 mmHg, without antiglaucoma medications, without further antiglaucoma surgery and without any sight-threatening complication. RESULTS: The mean age of patients was 8.8+/-5.5 years at the time of trabeculectomy with MMC compared to 11.0+/-12.4 years for trabeculectomy without MMC. Eight patients underwent trabeculectomy with MMC and 11 patients underwent trabeculectomy without MMC. There was no statistically significant difference between the two groups in terms of visual acuity, IOP, antiglaucoma medications, age at cataract surgery and at trabeculectomy. The IOP reduced from a preoperative level of 34.2+/-8.9 mmHg (range: 20-52) to a postoperative level of 18.4+/-12.2 mmHg (range: 2-60) with a mean follow-up of 24.2+/-17.9 months. The mean reduction in IOP in the MMC group was 15.5+/-17.3 and 16.3+/-13.8 mmHg in the other group (P = 0.967). Overall, complete success was achieved in 36.8%, qualified success in 21.1% and surgical failure in 42.1% of patients with a mean follow-up of 24.2+/-17.9 months. There was no difference in the success between the two groups at the last follow-up. One patient developed bleb-related endophthalmitis in both eyes following trabeculectomy with MMC. CONCLUSIONS: The success rate of trabeculectomy in glaucoma following congenital cataract surgery was 36.8% at the end of 3 years. The present study proves a poor success rate of trabeculectomy in a small series of aphakic Asian Indian patients even with the use of MMC.
Adolescent↗
Otago Glaucoma Surgery Outcome Study. Atypical late failure of drainage following clear cornea trabeculectomy.
BACKGROUND: Bleb scarring is the major cause of late drainage failure following the standard trabeculectomy. To overcome this, Cairns described a modification of his original technique, which he termed the clear cornea trabeculectomy. The essential feature was communication between the anterior chamber and subconjunctival space without intraoperative disturbance of the conjunctival or Tenon's tissue. As there is little published data on Cairns' clear cornea trabeculectomy, this study aimed to assess the long-term success of this procedure relative to conventional trabeculectomy. METHODS: Patients who underwent clear cornea trabeculectomy at Dunedin Hospital were identified. Cases in which late failure occurred were subject to a detailed review. Records of all patients in whom late failure of drainage occurred following conventional trabeculectomy performed since 1985 were also reviewed. The nature of late drainage failure associated with these different procedures was assessed. RESULTS: Late failure of drainage occurred in three of 21 eyes following clear cornea trabeculectomy. In each case there was an accelerated drainage failure with a dramatic rise in intraocular pressure. Consequent visual loss occurred in two patients. Late failure occurred in 32 of the 450 cases of conventional trabeculectomy, in all of which the pressure rise was gradual and less acute. CONCLUSIONS: This report highlights a previously unreported type of late failure associated with clear cornea trabeculectomy, which may result in significant visual loss. This reinforces the view that the standard Cairns' trabeculectomy is a safer procedure.
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[Comparison of postoperative recovery after trabeculectomy for pseudoexfoliation glaucoma and chronic primary open angle glaucoma].
BACKGROUND: A former study showed an increased biochemical and tyndallometrical concentration of proteins in the anterior chamber in eyes with pseudoexfoliation glaucoma (PEX). This may induce an increased healing process, which may reduce the effectiveness of a trabeculectomy. To evaluate the intraocular pressure (IOP) lowering effect of trabeculectomy over time in eyes with PEX and primary open angle glaucoma (POAG) a retrospective study was conducted. METHODS: Thirty eyes of 30 patients with PEX were matched to 30 eyes of 30 patients with POAG in terms of age, glaucoma medication, and visual field loss. All patients underwent primary trabeculectomy by one surgeon without the use of antimetabolites. Maximum IOP and the duration of antiglaucomatous therapy before trabeculectomy was evaluated. IOP readings were analyzed before and 1 day, 1, and 2 years after trabeculectomy. Statistical evaluation was performed by Mann and Whitney's U-test. RESULTS: Patients with PEX showed a significant higher maximum IOP and a significant shorter duration of antiglaucomatous therapy before trabeculectomy. Both groups showed no significant differences in IOP before and after trabeculectomy. In the group with PEX a tendency to a lower IOP was found 1 year (p(U) = 0.13) and 2 years (p(U) = 0.16) after trabeculectomy. There was no significant difference in antiglaucomatous therapy after trabeculectomy. CONCLUSIONS: This study did not find a reduced IOP lowering effect of trabeculectomy in eyes with PEX in comparison to eyes with POAG over time.
Aged↗
Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study.
OBJECTIVE: To determine the results of temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy plus low-dose 5-fluorouracil compared with trabeculectomy plus low-dose 5-fluorouracil. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive case patients who underwent temporal corneal phacoemulsification combined with superior trabeculectomy plus low-dose 5-fluorouracil (case [combined surgery] group) and 40 control patients, matched for age race, preoperative intraocular pressure (IOP), number of preoperative antiglaucoma medications, and number of 5-fluorouracil injections, who underwent trabeculectomy alone plus low-dose 5-fluorouracil (control [trabeculectomy] group). MAIN OUTCOME MEASURES: Survival analyses for IOP control compared between the 2 groups. METHODS: The medical records of 40 consecutive case patients were reviewed to determine the effect of their treatment on IOP, visual acuity, and requirement for glaucoma medications. In the control group, 40 eyes (1 eye per patient) were randomly selected for comparison with the case group. In both groups, the trabeculectomy was located superiorly and performed with the same technique and using a limbus-based conjunctival flap. In the case group, temporal corneal phacoemulsification immediately preceded trabeculectomy and used a 3.2-mm incision and a 1-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-fluorouracil injections of 5 mg each within the first 11 postoperative days. Patients were followed up for at least 1 year. Success of surgery was defined as an IOP of less than 22 mm Hg and a 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications. RESULTS: The mean (+/-SD) postoperative IOP was statistically higher in the case group than in the control group at each follow-up interval (P < .05). The mean (+/-SD) IOP reductions at 1 year were 6.8 +/- 5.5 mm Hg and 10.3 +/- 7.6 mm Hg (39.2% +/- 18.8%) in the case and control groups, respectively (P = .04). The reductions in the mean (+/-SD) number of antiglaucoma medications at 1 year were 1.6 +/- 0.9 and 2.0 +/- 1.0 in the case and control groups, respectively (P = .06). In the case group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < .001). Kaplan-Meier survival analysis showed that the cumulative success rates at 2 years were 62.1% and 85.8% in the case and control groups, respectively. The survival time to failure was significantly shorter (P = .04) in the case group by the log-rank test. CONCLUSIONS: Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone despite identical trabeculectomy techniques used in both groups. Nevertheless, combined surgery lowers IOP and reduces the long-term requirement for antiglaucoma medications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.
Aged↗
Treatment outcomes in the tube versus trabeculectomy study after one year of follow-up.
PURPOSE: To report one-year results of the Tube Versus Trabeculectomy (TVT) Study. DESIGN: Multicenter randomized clinical trial. METHODS SETTING: 17 Clinical Centers. STUDY POPULATION: Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. INTERVENTIONS: 350 mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). MAIN OUTCOME MEASURES: IOP, visual acuity, and reoperation for glaucoma. RESULTS: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At one year, IOP (mean +/- SD) was 12.4 +/- 3.9 mm Hg in the tube group and 12.7 +/- 5.8 mm Hg in the trabeculectomy group (P = .73). The number of glaucoma medications (mean +/- SD) was 1.3 +/- 1.3 in the tube group and 0.5 +/- 0.9 in the trabeculectomy group (P < .001). The cumulative probability of failure during the first year of follow-up was 3.9% in the tube group and 13.5% in the trabeculectomy group (P = .017). CONCLUSIONS: Nonvalved tube shunt surgery was more likely to maintain IOP control and avoid persistent hypotony or reoperation for glaucoma than trabeculectomy with MMC during the first year of follow-up in the TVT Study. Both surgical procedures produced similar IOP reduction at one year, but there was less need for supplemental medical therapy following trabeculectomy with MMC.
Adolescent↗
The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty.
PURPOSE: To investigate the association of pre-intervention and post-intervention patient and eye characteristics with failure of argon laser trabeculoplasty (ALT) and trabeculectomy. DESIGN: Cohort study of participants in the Advanced Glaucoma Intervention Study. METHODS: This multicenter study took place between 1988 and 2001. Between 1988 and 1992, 789 eyes of 591 patients aged 35 to 80 years with advanced glaucoma were randomized into one of two surgical treatment sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy or trabeculectomy-ALT-trabeculectomy. Upon study-defined failure (based on maximum medications, sustained intraocular pressure (IOP) elevation, visual field defect, and disk rim deterioration) of each intervention, patients were offered the subsequent intervention. Potential follow-up was 8 to 13 years. This report is based on data from 779 eyes that had at least 3 months of follow-up. The main outcome measures are failure of ALT and trabeculectomy, whether as first or second interventions. Effect size is measured by the hazard ratio (HR) and its corresponding 95% confidence interval (CI) obtained from Cox multiple regression analysis, where HR corresponds to the coefficient of change in risk associated with a unit increase in a factor. For binary factors, this corresponds to the change in risk in eyes with the factor relative to the risk in eyes without the factor. RESULTS: Pre-intervention factors associated with failure of ALT are younger age (HR = 0.98, CI = 0.96-0.99, P =.009) and higher IOP (1.11, 1.08-1.15, P <.001). Pre-intervention factors associated with failure of trabeculectomy are younger age (HR = 0.97, CI = 0.95-0.99, P =.005) and higher IOP (1.04, 1.01-1.06, P =.002), as well as diabetes (2.86, 1.88-4.36, P <.001) and any postoperative complication (1.99, 1.35-2.93, P <.001). Individual postoperative complications significantly associated with increased risk of failure of trabeculectomy are elevated IOP (3.4, 1.9-6.1, P <.001) and marked inflammation (2.4, 1.3-4.6, P =.006). CONCLUSIONS: In this study, ALT failure was associated with younger age and higher pre-intervention IOP. Trabeculectomy failure was associated with younger age, higher pre-intervention IOP, diabetes, and one or more postoperative complications, particularly elevated IOP and marked inflammation.
Adult↗
Corneal trabeculectomy without conjunctival incision. Extended follow-up and histologic findings.
BACKGROUND: Corneal trabeculectomy, a guarded filtration procedure without conjunctival incision but with an iridectomy, was developed in 30 eyebank and 20 rabbit eyes before being applied to humans. METHODS: Corneal trabeculectomy was performed in one eye and conventional trabeculectomy in the contralateral eyes of six rabbits. Sequential postoperative histologic examinations were performed on these eyes at various times after surgery. Corneal trabeculectomy also was performed in 20 eyes of 18 patients with glaucoma for control of their intraocular pressure (IOP). RESULTS: Results of histologic examination on these rabbit eyes showed less subconjunctival inflammation and fibrosis after corneal trabeculectomy than conventional trabeculectomy. In the eight patients with glaucoma who had had their surgery at least 1 year previously, the mean IOP decreased from 31 mmHg (preoperatively) to 14 mmHg. Eighty-eight percent have IOPs less than or equal to 18 mmHg without medications or revision. CONCLUSION: Extended follow-up shows that corneal trabeculectomy is a low-tech, relatively atraumatic filtration procedure without conjunctival incision, which produces diffuse and persistent blebs and controls IOP. Results of sequential postoperative histologic examination in rabbit eyes suggest that corneal trabeculectomy may incite less subconjunctival inflammation than conventional trabeculectomy.
Adult↗
The National Survey of Trabeculectomy. II. Variations in operative technique and outcome.
PURPOSE: There is a considerable body of literature relating to trabeculectomy; however, there are no data representative of the national experience of trabeculectomy in the United Kingdom (UK). The Department of Health funded a national survey of trabeculectomy to establish current practice patterns and the outcome of trabeculectomy in the National Health Service (NHS). In this paper we report variations in surgical technique and the national success rate of trabeculectomy. METHODS: A cross-sectional survey was carried out of consultant ophthalmologists performing trabeculectomy in the NHS. Participants recruited their four most recent consecutive first-time trabeculectomy cases according to study eligibility criteria and data were collected by self-administered questionnaire. FOLLOW-UP: 1 year post-trabeculectomy. Main outcome measure of success: final intraocular pressure (IOP) less than two-thirds the pre-operative IOP. Secondary outcome measures of success: final IOP less than 21 mmHg and visual field stability. Success was further defined as unqualified (excluding patients on anti-glaucoma medications at final follow-up) or qualified (including patients on anti-glaucoma medications at final follow-up). The relationship between variables characterising consultants' practice and main outcome measure was examined by chi-square test. RESULTS: Clinical outcome data were available for 1240 (85.3%) cases. There were wide variations in operative technique. The mean post-operative IOP was 14.4 mmHg (95% CI 14.2-14.7), which is a mean reduction of 11.8 mmHg (95% CI 11.4-12.2). An unqualified success, in terms of the main outcome measure, was achieved in 66.6% of patients and a qualified success in 71.0% of cases. An unqualified success, in terms of a final IOP less than 21 mmHg, was achieved in 84.0% of cases and a qualified success in 92.0%. Visual fields were stable in 84.2%. Outcome was not related to consultants' specialist interest, level of activity, type of hospital or region. CONCLUSIONS: The success rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. The national success rate at 1 year compares favourably with many studies in the literature. This survey provides valid and clinically relevant measures of success for the production of guidelines and standards for audit at regional, local and individual level and a baseline for the comparison of new therapies.
Antimetabolites↗
[Glaucoma and cataract: combined operation or trabeculectomy first and cataract extraction later?].
BACKGROUND: The aim of this retrospective study is to evaluate the difference in postoperative intraocular pressure (IOP) control, number of antiglaucoma medications and visual acuity (VA) between combined phacoemulsification and trabeculectomy (Glaucoma triple) surgery and two-stage procedures with trabeculectomy first and cataract extraction later. PATIENTS AND METHODS: Two groups of glaucoma patients were assessed: In group 150 consecutive patients undergoing combined phacoemulsification and trabeculectomy were enrolled. In group two, 51 consecutive patients were included, that had undergone trabeculectomy first and cataract surgery later. The mean interval between the two procedures was 3.2 years, 35/51 patients (71%) underwent conventional extracapsular cataract extraction, the other 16 patients (29%) had phacoemusification via clear cornea incision. RESULTS: One year postoperative both groups revealed a significant IOP reduction. IOP-reduction was significantly better in the two-stage group one year after trabeculectomy (12.8 +/- 4.0 mm Hg) and one year after cataract extraction (14.0 +/- 2.8 mm Hg) as compared to the combined surgery group (15.3 +/- 4.0 mm Hg). Kaplan-Meier survival analysis revealed a 90% success-rate 12 months after trabeculectomy only as compared to 65% success-rate in the combined surgery group. The number of antiglaucoma medications was significantly reduced in both groups. One year after cataract surgery no difference in VA could be seen between the two groups. CONCLUSIONS: If medically uncontrolled glaucoma with advanced optic nerve head changes in patients with coexisting glaucoma and cataracts is the main indication for surgery, a two-stage procedure (i.e. trabeculectomy first, cataract extraction later) yields better long-term IOP control. If glaucoma is medically controlled with a simple regimen, conjunctiva-sparing cataract surgery may be the treatment of choice. In all other cases of coexisting glaucoma and cataract combined phacoemulsification and trabeculectomy (Glaucoma triple) is preferrable, either performed through a single incision or as two separate procedures in the same session (i.e. trabeculectomy from above, phacoemulsifiaction via clear cornea from temporal).
Age Factors↗