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PubMed2004

Factors associated with success in first-time trabeculectomy for patients at low risk of failure with chronic open-angle glaucoma.

PURPOSE: To examine the relationships between study factors and trabeculectomy outcome in a representative sample of United Kingdom ophthalmology surgeons and patients. DESIGN: Cross-sectional observational study by questionnaire. PARTICIPANTS: All ophthalmic surgeons performing trabeculectomy in the National Health Service were invited to select their 4 most recent consecutive trabeculectomy cases satisfying study eligibility criteria before June 1996. Three hundred eighty-two surgeons supplied baseline data for 1450 patients and 1-year follow-up data for 1240 (85.3%) patients. All patients had undergone first-time trabeculectomy for chronic open-angle glaucoma. METHODS: Data were collected by self-administered questionnaires at baseline and 6 and 12 months postoperatively. Univariate analysis of the relationships between study factors and success was performed by chi-square test (categorical variables) and Student's t or Mann-Whitney U tests (continuous variables). Multiple logistic regression modeling of explanatory variables significant at a P value of </=0.1 was then performed. MAIN OUTCOME MEASURE: Trabeculectomy success, defined as a final intraocular pressure (IOP) less than two thirds of the preoperative IOP, excluding patients on antiglaucoma medications. RESULTS: After multiple logistic regression modeling, diabetes (odds ratio [OR] = 0.485, 95% confidence interval [CI] = 0.271-0.868, P = 0.015), superior rectus traction suture (OR = 0.580, 95% CI = 0.348-0.959, P = 0.034), subconjunctival anesthetic (OR = 0.172, 95% CI = 0.065-0.459, P<0.0001), and nonspecialist surgeons (OR = 0.539, 95% CI = 0.335-0.865, P = 0.010) remained significantly associated with poorer outcome. CONCLUSIONS: In this nationally representative sample of glaucoma patients undergoing first-time trabeculectomy, we have identified important associations between diabetes, superior rectus traction suture, subconjunctival anesthetic, nonspecialist surgeons, and diminished trabeculectomy success. These associations merit further examination.

Aged↗
PubMed2000

Ahmed glaucoma valve implant vs trabeculectomy in the surgical treatment of glaucoma: a randomized clinical trial.

PURPOSE: To compare the short- and intermediate-term results of two commonly used glaucoma surgical procedures, trabeculectomy and Ahmed glaucoma valve implant. METHODS: A randomized clinical trial was performed at two international centers. One eye each of consecutive patients requiring glaucoma surgery for intraocular pressure control was randomized to receive either trabeculectomy or the Ahmed implant. RESULTS: Of the 117 patients, 62 were randomized to trabeculectomy and 55 to the Ahmed implant. With a mean follow-up of 9.7 months, the trabeculectomy group had statistically lower intraocular pressures at weeks 6 to 15 (12.6 mm Hg vs 16.4 mm Hg) and months 11 to 13 (11.4 mm Hg vs 17.2 mm Hg) than the Ahmed implant group. Compared with preoperative status, no statistically significant differences between groups were noted for visual acuity, visual field, lens status, and final anterior chamber depth. The cumulative probabilities of success (intraocular pressure <21 mm Hg and at least 15% reduction in intraocular pressure from preoperative level) were 83.6% for trabeculectomy and 88.1% for Ahmed implant (P =.43). However, the Ahmed implant group had a greater adjunctive medication requirement. On the last visit, 10 of the trabeculectomy eyes and 19 of the Ahmed implant eyes required at least one topical medication (P =.01). There was no statistically significant difference in the rate of complications between the two groups. CONCLUSIONS: Lower mean intraocular pressures were noted for the trabeculectomy group. All other results, including success (as defined in this study) and frequency of complications, were comparable between the two groups.

Female↗
PubMed1996

Long-term results of combined cataract and glaucoma surgery versus trabeculectomy alone in low-risk patients.

PURPOSE: To compare the long-term results of combined extracapsular cataract extraction (ECCE), intraocular lens (IOL) implantation, and trabeculectomy with those of trabeculectomy alone in low-risk patients. SETTING: An ophthalmic department in a British general district hospital. METHODS: We did a retrospective analysis of the case records of all low-risk patients who had either combined ECCE, IOL implantation, and trabeculectomy (combined group) or trabeculectomy alone between August 1991 and February 1993 with a minimum of 12 months follow-up (mean 21 months). The combined group comprised 21 patients (14 women) and the trabeculectomy group, 24 patients (18 women). The mean ages were 79.8 years (range 66 to 90 years) and 76.0 years (range 61 to 87 years), respectively. We measured final intraocular pressure (IOP), number of medications used, best corrected visual acuity, visual field, and complication rates. RESULTS: Average IOPs at diagnosis, the preoperative visit, and last follow-up visit were 27.6, 23.1, and 15.6 mm Hg, respectively, in the combined group and 31.8, 26.7, and 15.3 mm Hg, respectively, in the trabeculectomy group. The differences between groups were not statistically significant at any stage. All patients had an IOP lower than 22 mm Hg at the last follow-up. In more than 75% of patients in the combined group, visual acuity improved by more than one Snellen line. CONCLUSIONS: The combined procedure compared favorably with trabeculectomy alone in low-risk patients.

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PubMed2004

Outcome of consecutive trabeculectomy.

PURPOSE: To establish a criterion for success of primary phakic trabeculectomy in the second eye of the same patient, using the first operated eye as a predictor for the surgical outcome. METHODS: The outcome of primary phakic trabeculectomy was retrospectively compared in both eyes of 23 patients. Sixteen patients were treated with antimetabolites and seven were not. Postoperative intraocular pressure and number of glaucoma medications in paired eyes of the same patients were compared. Surgical success was defined as postoperative IOP of <20 mmHg without medication. Bleb morphology and the number of glaucoma medications were also compared in both eyes. RESULTS: There was a positive correlation between the two eyes of a patient in the IOP values at each postoperative time point in both groups (with and without antimetabolites) (P > 0.05). At the last follow-up visit after trabeculectomy, the number of glaucoma medications used in paired eyes were not significantly different (P > 0.83). Surgical failure occurred more often in paired eyes than in single eyes. Bilateral failure occurred in 60% (3/5) of the failed trabeculectomies with antimetabolites and in 100% (3/3) of the failed trabeculectomies without antimetabolites. CONCLUSION: Trabeculectomy outcome in paired eyes of patients was similar in both antimetabolites treated and untreated eyes. Thus, trabeculectomy outcome in the first operated eye can predict the surgical result in the second eye of the same patient.

Adolescent↗
PubMed2002

A prospective randomized trial of viscocanalostomy versus trabeculectomy in open-angle glaucoma: a 1-year follow-up study.

PURPOSE: To assess the intraocular pressure-lowering efficacy and the postoperative complication profile of viscocanalostomy versus trabeculectomy. PATIENTS AND METHODS: Sixty eyes of 60 patients with medically uncontrolled open-angle glaucoma were randomized either to the viscocanalostomy or to the trabeculectomy group of the trial. Viscocanalostomy was performed according to Stegmann's technique using high-molecular-weight sodium hyaluronate to fill the ostia of the Schlemm canal. For trabeculectomy, a modified Cairns-trabeculectomy was performed. Examinations were performed before surgery and postoperatively daily for 1 week. Follow-up visits were scheduled 1, 6, and 12 months after surgery. RESULTS: The mean (SD) preoperative intraocular pressure was 27.1 (7.1) mm Hg for all patients enrolled. One day after surgery, mean (SD) intraocular pressure was 15.9 (5.2) for the trabeculectomy group (P <0.001) and 15.7 (3.6) for the viscocanalostomy group (P <0.001), respectively. The success rate, defined as an intraocular pressure lower than 22 mm Hg without medication, was 56.7% in the trabeculectomy group and 30% in the viscocanalostomy group at 12 months postoperatively (P = 0.041). The number of postoperative complications was lower in the viscocanalostomy group than in the trabeculectomy group. CONCLUSIONS: In eyes with open-angle glaucoma, viscocanalostomy is less effective in reducing intraocular pressure than standard filtering surgery. However, postoperative complications are more frequent after filtering surgery.

Conjunctiva↗
PubMed1997

Phacoemulsification trabeculectomy compared to other methods of combined cataract and glaucoma surgery.

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.

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PubMed2004

Early postoperative trabeculectomy leakage: incidence, time course, severity, and impact on surgical outcome.

AIM: To establish the incidence, time course, and severity of conjunctival wound leakage following trabeculectomy, and also to establish whether early wound leakage adversely affects the ultimate outcome of the surgery. METHOD: A prospective, observational case series of sequential trabeculectomies performed in a single institution over a 12 month period. Datasets on 286 operations were analysed. A fornix based conjunctival flap was used in 254 cases and a limbus based conjunctival flap in 41 cases. At every postoperative visit trabeculectomies were assessed for four grades of leakage (none; mild; moderate; severe), and for success or failure at the 6 month follow up post surgery. Pressure was applied to the trabeculectomy bleb to record the maximum rates of leakage and improve kappa statistics. Study clinicians were validated with respect to their scoring of leaks before starting the study. RESULTS: 169 of the 286 trabeculectomies (59%) showed leakage at some stage postoperatively. 159 of 245 fornix based flaps (65%) leaked compared with 10 of 41 limbus based flaps (24%). Median time to leak was 3.5 (range 0-408) days. Median duration of leakage was 14 (range 2-457) days. 14 (5%) of trabeculectomies failed completely. A further 40 (14%) were a partial failure. In total, 23 of 117 (20%) without postoperative leaks partially or completely failed compared with 31 of 169 (18%) with leaks. Cross tabulation of partial and complete failure by leak shows no evidence of an adverse effect of leaking on the outcome (chi(2) = 1.81, p = 0.4). CONCLUSIONS: There is no evidence to support the hypothesis that early postoperative leakage of fornix based conjunctival flaps affects the outcome of trabeculectomy.

Aqueous Humor↗
PubMed2005

Changes in axial length following trabeculectomy and glaucoma drainage device surgery.

AIM: This study examines the changes in axial length (AL) after trabeculectomy and glaucoma drainage device (GDD) surgery and enabled an equation to be derived allowing prediction of AL change after filtering surgery. METHODS: This was a prospective, interventional case series from the Glaucoma Service of the Doheny Eye Institute. PATIENT POPULATION: One eye of 39 patients undergoing trabeculectomy and 22 undergoing Baerveldt tube shunt implantation for uncontrolled glaucoma. INTERVENTION: These patients had AL measurements by non-contact, partial coherence interferometry preoperatively, at 1 week, 1 month, and >3 months after surgery. MAIN OUTCOME MEASURES: Axial length and intraocular pressure were compared at preoperative and postoperative visits. Postoperative intraocular pressure (IOP) was categorised as hypotonous (0-4 mm Hg), low (5-9), normal (10-17), and high (18 or more). RESULTS: There was a statistically significant reduction in IOP after 3 months of -12.8 (SD 1.5) mm Hg following trabeculectomy (p<0.001), and -10.7 (1.9) mm Hg after GDD (p<0.001). There was a statistically significant reduction in AL, which was similar after trabeculectomy and GDD at all time points (p<0.001), of -0.15 (0.03) and -0.21 (0.04) mm (1 week), -0.18 (0.02) and -0.10 (0.02) mm (1 month), and -0.16 (0.03) and -0.15 (0.03) mm (3 months). At 3 months or later the AL reduction was related to postoperative IOP and to the amount of IOP reduction (p<0.05, stepwise multiple regression). 10.2% (4/39) of trabeculectomy patients had hypotony after 3 months, with a mean AL reduction (-0.39 (0.11)) that was statistically significantly lower (p<0.01) than the other trabeculectomy eyes (-0.14 (0.15)). CONCLUSIONS: There is a small but statistically significant decrease in AL after both trabeculectomy and GDD surgery, greater in eyes that are hypotonous after surgery. The authors suggest that AL reduction can be predicted after 3 months by the formula: AL reduction (mm) = -199+0.006 x IOP reduction+0.008 x final IOP.

Aged↗
PubMed2005

Effect of trabeculectomy on ocular blood flow.

BACKGROUND/AIM: Current evidence suggests that vascular insufficiencies in the optic nerve head play an important part in the pathogenesis of glaucomatous optic neuropathy. Trabeculectomy is the most common operative procedure for the treatment of medically uncontrolled glaucoma. This study was conducted to investigate whether trabeculectomy may improve ocular haemodynamics. METHODS: 30 patients with primary open angle glaucoma about to undergo trabeculectomy were included in the study. Patients were evaluated before surgery and at 2 and 10 weeks after trabeculectomy. Optic nerve head blood flow (OnhBF) was assessed with scanning laser Doppler flowmetry. Fundus pulsation amplitude (FPA) measurements were obtained with laser interferometry. RESULTS: Because of the decrease in intraocular pressure there was a significant increase in ocular perfusion pressure (OPP) following trabeculectomy (18.5% (SD 12.0%) and 19.0% (17.1%) at 2 and 10 weeks postoperatively; p <0.001). A significant increase in OnhBF was observed after trabeculectomy (11.6% (16.4%) and 16.2% (20.2%) for each postoperative visit, respectively; p <0.001). FPA was also significantly higher compared with baseline values (17.2% (17.3%) and 17.4% (16.3%), respectively; p <0.001). A significant association between the increase in OPP and the increase in OnhBF and FPA was observed 10 weeks after surgery (r = 0.47; p = 0.009, and r = 0.50; p = 0.005, respectively). CONCLUSION: The results of this study suggest that trabeculectomy improves ocular blood flow in patients with chronic open angle glaucoma.

Aged↗
PubMed1996

Long-term follow up of primary trabeculectomy for infantile glaucoma.

BACKGROUND: The treatment for infantile glaucoma is surgical. Treatment options include goniotomy, trabeculotomy, combined trabeculotomy-trabeculectomy, and trabeculectomy. METHODS: Patients who had a follow up of 5 years or longer after primary trabeculectomy were examined to determine the long term stability in infantile glaucoma. RESULTS: In eyes with primary infantile glaucoma 92.3% achieved control of their glaucoma with a single trabeculectomy; 100% achieved control with two trabeculectomies; 85.7% of eyes with secondary infantile glaucoma achieved control with a single trabeculectomy. There were no serious complications experienced in either group. CONCLUSION: Primary trabeculectomy is a safe and successful operation for infantile glaucoma.

Case-Control Studies↗
PubMed1999

Age over 46 years does not affect the pressure lowering effect of trabeculectomy in primary open angle glaucoma.

BACKGROUND/AIMS: Previous reports have suggested that the success rate for trabeculectomy is poorer in younger age groups but these studies often have heterogeneous groups representing different types of glaucoma with variable surgical prognosis. Therefore, the relation between age and the success of trabeculectomy in the single diagnostic category of primary open angle glaucoma (POAG) without identifiable risk factors was examined for failure in the age range 46-85 years. METHODS: The records of 208 patients who had undergone a first trabeculectomy for POAG were examined retrospectively. Age ranged from 46 to 85 (mean 66.7 years). The outcome of surgery was examined at final available follow up and at 1 and 2 years after surgery. Trabeculectomy was considered a success if intraocular pressure was < or = 21 mm Hg with or without additional medical treatment ("cumulative" success) and an "absolute" success if intraocular pressure was < = 21 mm Hg without additional medical treatment. RESULTS: Cumulative success for trabeculectomy was 92.3% at final follow up and 96.6% at 2 year follow up; absolute success rate was 66.3% at final follow up and 71.6% at 2 years. There was no significant trend for greater success of trabeculectomy in the older age groups (cumulative success at 2 year follow up, chi 2 for linear trend 1.07 (p = 0.3) nor was the drop in intraocular pressure following surgery significantly greater with increasing age (analysis of variance for intraocular pressure lowering from presentation to 2 years' follow up (Kruskal-Wallis, t = 5.9, p = 0.55). Patients with pseudoexfoliation were excluded from the main analysis as these patients have been shown to have a lower final intraocular pressure following trabeculectomy, a finding which was confirmed in this study.

Age Factors↗
PubMed1996

Incidence of ptosis following trabeculectomy: a comparative study.

The occurrence of ptosis after trabeculectomy has been a common postoperative complication. Many factors have been implicated in the development of postoperative ptosis. The purpose of this study was to investigate the incidence of ptosis following trabeculectomy and whether or not it was influenced by combined cataract surgery, type of conjunctival flap, and previous intraocular surgery. We reviewed 386 eyes of 386 patients who underwent either trabeculectomy alone or trabeculectomy combined with cataract surgery, with greater than 6 month follow-up. Ptosis occurred in 10.7% (18 of 150 eyes) after trabeculectomy alone and in 12.7% (30 of 236 eyes) after trabeculectomy with combined cataract surgery (p = 0.96). The incidence of ptosis was 12.3% (10 of 81 eyes) after limbus-based conjunctival flap and 12.5% (38 of 305 eyes) after fornix-based conjunctival flap (p = 0.98). There was no significant difference in the incidence of ptosis between primary surgery eyes (12.5%, 34 of 273 eyes) and secondary surgery eyes (12.4%, 14 of 113 eyes) (p = 0.97). The incidence of ptosis after trabeculectomy was about 12% overall and not significantly influenced by combined cataract surgery, type of conjunctival flap or previous ocular surgery.

Adolescent↗
PubMedDate not supplied

Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy.

CONTEXT: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome. AIMS: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C. SETTINGS AND DESIGN: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy. METHODS AND MATERIAL: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period. STATISTICAL ANALYSIS USED: Chi square test, paired t test, odds ratio, effect size. RESULTS: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup. CONCLUSIONS: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.

Adult↗
PubMedDate not supplied

Results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma.

BACKGROUND AND OBJECTIVE: To report the results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma. PATIENTS AND METHODS: The medical records of Chinese patients who received trabeculectomy with intraoperative mitomycin C from 1992 to 1998 were retrospectively reviewed. A "successful" trabeculectomy was defined as one after which the intraocular pressure (IOP) could be controlled to between 5 and 21 mm Hg, inclusive, with no more than 3 glaucoma medications. RESULTS: One hundred fourteen trabeculectomies in 105 eyes of 90 patients were retrospectively reviewed. Mean age +/- standard deviation was 48.1 +/- 21.9 years. Primary open-angle glaucoma (43.0%) and angle-closure glaucoma (27.2%) were the most common diagnoses leading to trabeculectomy. The mean follow-up +/- standard deviation was 29.6 +/- 18.6 months (range, 6 to 92 months). The overall success rate at the last follow-up was 73.7% (84 of 114 trabeculectomies). CONCLUSIONS: Trabeculectomy with mitomycin C is a safe and effective procedure for the control of IOP in Chinese patients with glaucoma.

Adolescent↗
PubMed1998

Results of trabeculectomy with 0.3 mg/ml mitomycin C titrating exposure times based on risk factors for failure.

PURPOSE: To examine the efficacy of trabeculectomy with mitomycin C 0.3 mg/ml using titrated exposure times. METHODS: A retrospective chart review of consecutive patients undergoing trabeculectomy in an academic referral glaucoma clinic was performed. All patients received trabeculectomies performed by one surgeon (M.B.S.). The study included 57 eyes of 57 patients using mitomycin C with exposure times titrated from one to five minutes based on risk factors for trabeculectomy failure. Surgical success was defined as a final intraocular pressure (IOP) of less than 21 mmHg with or without medications or a 25% reduction in IOP if preoperative IOP was 21 mmHg or less. Patients requiring repeat trabeculectomies were considered failures regardless of their final IOP. Patients receiving different mitomycin C exposure times were compared but statistical analysis was not used because these subgroups were not randomized. RESULTS: An overall surgical success rate of 84.2% was achieved at a mean follow-up of 11.9 months. The surgical success rate and percentage IOP reduction was similar between exposure time subgroups. Hypotonous maculopathy observed in three patients (5.3%). All cases of hypotonous maculopathy was occurred in the lower-risk patients receiving one to three minute exposure times to mitomycin C. CONCLUSIONS: We believe mitomycin C should be used sparingly if at all in patients at lower risk for trabeculectomy failure. This concentration of mitomycin C with four to five minute exposure times appears to be efficacious for patients with multiple risk factors for trabeculectomy failure.

Administration, Topical↗
PubMed1984

Trabeculectomy in young patients.

The results of 117 trabeculectomies performed on 98 patients under the age of 50 years were reviewed. The success rate in primary glaucomas (29/39, 74%) was considerably higher than in secondary glaucomas (24/50, 48%) or in developmental glaucomas (6/17, 35%). Only one (9%) of 11 trabeculectomies performed for neovascular glaucoma was successful. Trabeculectomies for secondary glaucomas were significantly more often successful in eyes that had not undergone previous surgery. None of the six trabeculectomies performed on patients under the age of ten years controlled the intraocular pressure. Of the 45 trabeculectomies performed on patients aged 10 to 29 years, 17 (38%) were successful. Of the 66 trabeculectomies performed on patients aged 30 to 49 years, 43 (65%) were successful. The success rates among black, white, and hispanic patients were similar. The ability to identify patients at high risk for failure of trabeculectomy may be of value in guiding the surgical management of glaucoma.

Adolescent↗
PubMed1998

Outcomes of primary trabeculectomy with the use of adjunctive mitomycin.

OBJECTIVE: To investigate the efficacy and safety of adjunctive mitomycin when used during a primary trabeculectomy within a series of 89 consecutive patients at 1 and 2 years postoperatively. DESIGN: A cohort study of all patients who underwent primary trabeculectomy, performed by one of us (P.F.P.), between April 1, 1991, and December 31, 1994. Patients received topical mitomycin in conjunction with a corneal safety valve incision. A trabeculectomy was considered "successful" if it resulted in an intraocular pressure (IOP) of 21 mm Hg or lower and a 30% or greater reduction in the IOP at and after 1 year of follow-up, with or without medications and without a reoperation for an elevated IOP. Survival analysis was used to calculate success rates. RESULTS: The 1- and 2-year success rates were 85.4% and 77.9%, respectively. The mean IOP was reduced from 26.3 to 11.3 mm Hg at 1 year (n=68) and to 11.9 mm Hg at 2 years (n=56), with 60 (88.2%) of 68 patients off medication at 1 year and 47 (83.9%) of 56 patients off medication at 2 years. Trabeculectomy success rates were significantly lower in black compared with nonblack patients (76.2% vs 87.5% at 1 year, P=.03). Trabeculectomy failure occurred throughout the follow-up period. Endophthalmitis occurred in 2 (2.2%) of the patients, and hypotonia requiring revision occurred in 4 (4.5%) of the patients. CONCLUSIONS: Primary trabeculectomy with the use of intraoperative mitomycin lowered the IOP by 30% or more in 78% (at 2 years) to 86% (at 1 year) of the cases and is associated with a marked reduction in the percentage of patients who require glaucoma medication. Success rates must be evaluated in light of such risks as endophthalmitis and hypotony.

Administration, Topical↗
PubMed1994

Trabeculectomy with releasable sutures.

OBJECTIVE: To determine whether the use of releasable scleral-flap sutures affects the success rate and the incidence of complications following trabeculectomy. DESIGN: A retrospective chart review of a consecutive series of trabeculectomies. SETTING: A university-based referral practice. PATIENTS: Two hundred fifty-eight consecutive patients (274 eyes) undergoing trabeculectomy because of uncontrolled glaucoma. INTERVENTION: During the first year, 124 patients (128 eyes) underwent trabeculectomies with permanent scleral-flap sutures. During the second year, 134 patients (146 eyes) underwent trabeculectomies with releasable scleral-flap sutures. MAIN OUTCOME MEASURES: Incidence of flat and shallow anterior chamber, incidence of operations to drain choroidal detachment and to re-form anterior chamber, and long-term control of intraocular pressure. RESULTS: In the group with permanent sutures, 42 eyes (32.8%) had clinically detectable shallowing of the anterior chamber in the early postoperative period. In contrast, a shallow anterior chamber was noted in 21 eyes (14.4%) in the group with releasable sutures (P = .0003). Flat anterior chamber, defined as iridocorneal apposition to the pupil margin, occurred in 11 eyes with permanent sutures (8.6%) but in only two eyes (1.4%) with releasable sutures (P = .0078). Surgical intervention to drain suprachoroidal fluid and re-form the anterior chamber was required in eight eyes with permanent sutures (6.2%) but in only one eye with releasable sutures (0.7%) (P = .014). At 1-year follow-up, the two groups were similar in terms of intraocular pressure and the need for ocular hypotensive medications. CONCLUSIONS: Releasable scleral-flap sutures reduce the incidence of shallow and flat anterior chamber after trabeculectomy without compromising long-term control of intraocular pressure.

Aged↗