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PubMedDate not supplied

Trabeculectomy with mitomycin C: an electron microscopic and clinical study.

A prospective and randomized clinical trial was conducted to investigate the pressure-lowering effect of mitomycin C-aided trabeculectomy in the Turkish population. The scleral tissues excised during the operation were examined by light and electron microscopy. The study population consisted of 26 patients undergoing mitomycin C-aided trabeculectomy and another 26 patients subjected to trabeculectomy without mitomycin C serving as controls. The treatment groups consisted of primary open-angle and closed-angle glaucomas, congenital glaucomas, various types of secondary glaucomas and prior failed trabeculectomies. The decrease in IOP was more marked (P < 0.01) and the number of additional medications needed post-operatively was less in the mitomycin C group (P < 0.01). There were no serious complications except for transient hypotony in one mitomycin-treated eye. Transmission electron microscopic examinations showed differences between the control and mitomycin applied trabecular blocks. At the scleral dissection plane where mitomycin was applied, collagen fibrils were frayed with a loss of proteoglycan cross-links. Fibroblasts demonstrated pyknotic nuclei and loss of cell processes. In the control group, active fibroblasts and regular collagen structure were observed at this level. The middle and inner scleral layers were generally unaffected except for minor changes in some of the mitomycin-treated eyes. Our study showed mitomycin C to be safe and effective as adjunct to trabeculectomy in both primary open-angle, primary angle-closure, various secondary glaucomas and prior failed trabeculectomies. Transmission electron microscopic examinations of excised blocks showed disruption in collagen organization and cytopathic effects to fibroblasts. Mitomycin seemed to affect the proteoglycan cross-links between collagen fibrils after its application.

Adult↗
PubMed1989

Long-term results of 5-fluorouracil trabeculectomy for primary open-angle glaucoma.

The effect of 5-fluorouracil (5-FU) subconjunctival injection on the bleb formation and intraocular pressure (IOP) following trabeculectomy was studied in 27 primary open-angle glaucoma patients (33 eyes) who had never been operated upon (25 eyes) or had undergone single trabeculectomy that failed to reduce IOP (8 eyes). The results were analyzed by means of life table analysis and compared with those of 65 primary open-angle glaucoma eyes that had undergone trabeculectomy without postoperative administration of 5-FU as the first or the second filtering surgery. The surgical techniques and postoperative care were virtually identical between the eyes treated with 5-FU and the eyes that had undergone trabeculectomy without 5-FU. At the end of 28-month follow-up, the success probability was 74.8% without any postoperative antiglaucoma medication, and 100% with antiglaucoma medication. Whereas, the success probability with postoperative antiglaucoma medication was as low as 60.8% for the first, and 51.5% for the second trabeculectomy without 5-FU at the 24-month follow-up. Postoperative, subconjunctival injection of 5-FU appears to improve the prognosis following trabeculectomy in primary open-angle glaucoma patients.

Adult↗
PubMed2001

Mini-trabeculectomy in eyes with high risk of scarring: midterm follow-up.

PURPOSE: To report on the surgical outcome after at least 1 year of follow-up of mini-trabeculectomy (without scleral radial incisions), which took place in eyes at high risk of postoperative filtering bleb scarring. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed on 26 eyes of 26 consecutive patients aged 40 years and older who had undergone a previous intraocular surgery or had had a post-traumatic recessed anterior chamber angle. The surgical procedure, a modification of the standard trabeculectomy, involved a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. During surgery, 0.4 mg per ml of mitomycin C was applied in the scleral pocket of each eye for 3 minutes. Of the 26 eyes, each of two eyes underwent an intraocular intervention during the first postoperative year and therefore was evaluated only for surgical complications. Another eye underwent inferior mini-trabeculectomy, and three other eyes did not complete 12 months of follow-up. Twenty eyes have completed 12 months or more of follow-up and were included in the midterm calculations of intraocular pressure control. RESULTS: Mean preoperative intraocular pressure (n = 20) was 32.2 +/- 9.5 mm Hg with 3.3 +/- 0.9 hypotensive medications. After 12 to 37 months (mean, 22.1 +/- 6.6) of follow-up, intraocular pressure was 20 mm Hg or less in 18 of 20 eyes (90%) and the mean intraocular pressure was 17.4 +/- 2.9 mm Hg (range, 12 to 23) with 1.1 +/- 1.2 hypotensive medications (range, 0 to 4). At that time, the filtering bleb was low and fleshy in appearance in 15 eyes (75%). Postoperative complications of the 22 eyes included early postoperative aqueous leakage in one eye (4.5%); cataract extraction took place in one eye and vitrectomy was performed in another eye, 7 and 3 months postoperatively, respectively. The four eyes that were excluded from the study had controlled intraocular pressure at the last examination. CONCLUSION: Mini-trabeculectomy in eyes with high risk of scarring was found efficacious and relatively safe. The relatively small peritomy, the tunnel approach, and the avoidance of radial incisions seem to offer important advantages over the standard trabeculectomy.

Aged↗
PubMed2001

Prognosis and risk factors for early postoperative wound leaks after trabeculectomy with and without 5-fluorouracil.

PURPOSE: To evaluate the prognosis of patients who develop early postoperative wound leaks after trabeculectomy, to determine risk factors for these leaks, and to document adverse outcomes. DESIGN: Multicenter randomized clinical trial. METHODS: Two-hundred thirteen patients with previous cataract surgery or failed filtering surgery were randomized to either trabeculectomy (standard group) or trabeculectomy with postoperative subconjunctival 5-fluorouracil injections (5-FU group). Masked measurements of intraocular pressure were performed throughout 5 years of follow-up. Failure was defined as a reoperation to control intraocular pressure or an intraocular pressure greater than 21 mm Hg with or without medication at or after the 1-year examination. An early postoperative wound leak was defined as one that developed within 2 weeks postoperatively, determined by daily topical fluorescein testing. RESULTS: At 1 year (5 years), the success rate for the 5-FU group was 80% (54%) in eyes without a leak, and 60% (28%) in those with a leak. The 1-year (5-year) success rate in the standard group was 50% (24%) in those without a leak and 44% (15%) with a leak. (P =.018, log-rank test, adjusted for treatment). Leaks were more common in the 5-FU group, 34/105 (32%), than in the standard treatment group, 22/108 (20%), (P =.066, chi(2)). More eyes with one-layer conjunctiva-Tenon capsule closure developed leaks 40/115 (35%) than those with two-layer closure 16/95 (17%) (P =.006, chi(2)). More eyes with a trabeculectomy located inferiorly 29/76 (38%) developed leaks than those done superiorly 27/137 (20%) (P =.006, chi(2)). Patients with leaks were older (66 years) than those without leaks (60 years) (P =.011, t test). CONCLUSION: An early postoperative wound leak was a risk factor for trabeculectomy failure. We recommend that trabeculectomy be performed in a superior location with a two-layer closure.

Antimetabolites↗
PubMed2003

Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy.

PURPOSE: To compare the long-term results of trabeculectomy and Ahmed glaucoma valve implant in the initial surgical management of primary open- and closed-angle glaucoma. DESIGN: Randomized controlled clinical trial. METHODS: One eye each of consecutive patients with primary glaucoma and without prior intraocular surgery was randomized to receive either trabeculectomy or the Ahmed implant. Large university-affiliated eye hospital in Columbo, Sri Lanka. RESULTS: Of 123 patients, 64 were randomized to trabeculectomy and 59 to the Ahmed implant. With a mean follow-up of 31 months, the trabeculectomy group had statistically lower intraocular pressures (IOP) during the first postoperative year. After the first year, the IOPs were comparable. No statistically significant differences between groups were noted for postoperative visual acuity, visual field, anterior chamber depth, and short-term or long-term complications. Adjunctive medication requirement was comparable for both groups. The cumulative probabilities of success (IOP <21 mm Hg and at least 15% reduction in IOP from preoperative levels) at the final follow-up period (months, 41-52) were 68.1% for trabeculectomy and 69.8% for Ahmed implant (P =.86). CONCLUSIONS: Lower IOPs were noted for the trabeculectomy group during the first year. With longer follow-up, the IOPs and the cumulative probabilities of success were comparable between the two groups.

Adolescent↗
PubMed2003

Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life.

PURPOSE: To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy. DESIGN: Retrospective, age-matched, comparative case series. METHODS: Forty-six eyes of 32 patients with mean age of 7.0 +/- 5.1 month (range, 1 to 22 months) and uncontrolled glaucoma, which received an aqueous shunt device (Ahmed glaucoma valve or Baerveldt implant), compared with 24 eyes of 19 patients with mean age of 5.3 +/- 4.8 months (range, 0.5 to 24 months), which received an MMC trabeculectomy. Surgical success was defined as intraocular pressure < 23 mm Hg on maximal glaucoma medication, no further glaucoma surgery performed or recommended, no devastating complication, and stable ocular dimensions (axial length and corneal diameter). RESULTS: Cumulative probabilities of success were 87% +/- 5.0% for the aqueous shunt group compared with 36% +/- 8.0% success in the trabeculectomy group at 12 months and 53% +/- 12% in the aqueous shunt group compared with 19% +/- 7% in the trabeculectomy group at 72 months (chi(2) of 23.5, P <.0001). Aqueous shunt implantation was associated with significantly more postoperative complications requiring a return to the operating room (21 of 46 eyes, 45.7%) compared with trabeculectomy with MMC (3 of 24 eyes, 12.5%, P =.0074). The most common postoperative procedure in the aqueous shunt group was tube repositioning, performed in 16 of 46 eyes (34.8%). CONCLUSIONS: Aqueous shunt implantation offers a significantly greater chance of successful glaucoma control in the first 2 years of life, compared with trabeculectomy with MMC. However, the enhanced success with aqueous shunt devices is associated with a higher likelihood of postoperative complications requiring surgical revision, most commonly tube repositioning.

Antibiotics, Antineoplastic↗
PubMed1993

Ocular hypotony after trabeculectomy with mitomycin C.

Because mitomycin C reduces the resistance to aqueous outflow normally provided by postoperative subconjunctival fibrosis, we would expect to see more frequent hypotony after trabeculectomy with mitomycin C than after standard trabeculectomy. To evaluate the incidence of hypotony in trabeculectomy with intraoperative mitomycin C use, we performed a retrospective analysis on 52 eyes of 48 patients who underwent trabeculectomy with mitomycin C. Mitomycin C concentration was 0.4 mg/ml in all eyes, and treatment time ranged from 3 1/2 to seven minutes. We defined hypotony as intraocular pressure lower than 5 mm Hg on two examinations at least four weeks apart and six weeks or more postoperatively. Overall, average intraocular pressure was 22.7 +/- 10.7 mm Hg preoperatively and 10.4 +/- 5.0 mm Hg postoperatively (P < .001), a mean reduction in intraocular pressure of 12.3 +/- 11.5 mm Hg (47.0%). Hypotony occurred in 17 of 52 eyes (32.7%). Seven eyes required trabeculectomy revision for hypotony. Hypotonous eyes received longer treatment with mitomycin C intraoperatively, with a mean application time of 5.3 +/- 1.0 minutes for hypotonous eyes and 4.7 +/- 0.8 minutes for nonhypotonous eyes (P = .03). Sixteen of 43 eyes (37.2%) undergoing primary filtration became hypotonous, as compared to one of nine (11.1%) eyes that had previous filtering procedures (chi 2 = 2.30, P = .13). Nine of 17 hypotonous eyes (52.7%) and five of 35 nonhypotonous eyes (14.3%) had loss of two or more lines of Snellen visual acuity. Hypotony occurred in nearly one third of eyes treated with mitomycin C during trabeculectomy in our study. There was a statistically significant (P = .03) association of hypotony with longer application time of mitomycin C, and a trend toward increased incidence of hypotony in primary filtration.

Adult↗
PubMedDate not supplied

Supraciliochoroidal fluid at an early stage after trabeculectomy.

PURPOSE: To detect the presence of supraciliochoroidal fluid (SCF) by ultrasound biomicroscopy (UBM) at an early stage after trabeculectomy. METHODS: Trabeculectomy with mitomycin C was performed on 14 patients (15 eyes) with medically uncontrolled glaucoma. The ciliary bodies were observed using UBM testing, which was conducted preoperatively and within 2 weeks after the procedure. RESULTS: SCF was detected postoperatively in 6 eyes. One eye also had choroidal detachment (CD), as seen with an indirect ophthalmoscope; and 5 eyes (33%) had SCF without intraocular inflammatory clinical signs, postoperative changes of the anterior chamber depth, or obvious CD. The SCF in 4 eyes disappeared within 4 weeks after the trabeculectomy. The intraocular pressure (IOP) was 6.4 +/- 3.4 mm Hg (mean +/- SD) when SCF was detected and it rose to 13.2 +/- 7.2 mm Hg when the SCF disappeared. The IOP was 11.4 +/- 4.0 mm Hg in the eyes without SCF, which was significantly higher than that seen in the eyes with SCF. CONCLUSIONS: At an early stage after trabeculectomy, SCF without subclinical CD was detected in some cases by UBM. Compared with the reported frequency of SCF after 3 or 6 months, our study revealed that SCF was present more frequently at an early stage after trabeculectomy. Our results may indicate that the presence of SCF is related to the early low IOP after trabeculectomy and that the disappearance of SCF induces the elevation of IOP.

Aged↗
PubMed2000

Trabeculectomy for acute primary angle closure.

OBJECTIVE: To analyze the results of trabeculectomy performed for all cases of acute primary angle closure (APAC). DESIGN: Retrospective, noncomparative case series PARTICIPANTS: Fifty-six consecutive patients who underwent trabeculectomy for APAC at two Singapore centers from 1993 through 1995. METHODS: The conventional treatment for APAC is to lower intraocular pressure (IOP) medically, after which laser peripheral iridotomy (PI) is performed. However, in Asian eyes, the acute attack is often refractory to standard treatment. Trabeculectomy is occasionally performed on eyes that do not respond to medical therapy, as well as eyes with APAC that respond to medical therapy but are assessed as having underlying chronic angle-closure glaucoma. In such cases, laser PI is not performed before trabeculectomy. MAIN OUTCOME MEASURES: The surgical outcome was assessed in terms of final IOP and the incidence of complications. Success was defined as final IOP less than 21 mmHg without medication, and qualified success was defined as final IOP less than 21 mmHg with medication. Patients whose IOP was more than 21 mmHg, required further glaucoma surgery, lost light perception, or whose eye became phthisical were classified as failures. RESULTS: The mean follow up was 22 months (range, 6-42 months). In group A, the medical failure group (n = 32), success in IOP control was obtained in 18 patients (56.2%), qualified success was achieved in 3 patients (9.4%), and failure resulted in 11 patients (34.4%). Ten patients (31.3%) encountered early postoperative complications such as shallow anterior chamber. In group B, the medical success group (n = 24), success in IOP control was achieved in 21 patients (87.5%), qualified success was achieved in 3 patients (12.5%), and there were no cases of failure. The incidence of postoperative complications was low (4 eyes [16.7%]). In terms of IOP outcome, trabeculectomy outcome was significantly worse in group A (P<0.001, Fisher's exact test). CONCLUSIONS: Because there is a high risk of surgical failure and complications, trabeculectomy may not be the procedure of choice in medically unresponsive cases of APAC.

Acute Disease↗
PubMed2002

Trabeculectomies in fellow eyes have an increased risk of tenon's capsule cysts.

OBJECTIVE: To assess outcomes and complications of primary trabeculectomies in fellow eyes in a large group of patients. The assumption was that first and fellow eyes undergoing fistulizing surgical procedures behave similarly in the postoperative period. DESIGN: Retrospective nonrandomized comparative trial (paired eye study). PARTICIPANTS: Over a 4-year period, 566 consecutive patients underwent primary trabeculectomy, all without antifibrotic agents. One hundred thirty-eight of these patients underwent bilateral surgery. INTERVENTION: A primary trabeculectomy was performed. MAIN OUTCOME MEASURES: Preoperative data, postoperative intraocular pressure, and visual acuity were monitored. In addition, complications and the need for consecutive surgical procedures were noted. RESULTS: The mean follow-up period of these trabeculectomies was 27.4 months (range, 7-62 months). Of the 124 bilateral adult cases, no statistical difference was found in intraocular pressures, number of antiglaucomatous medications, and success or failure rates between the two eyes. The need for enhancement procedures, such as needling or surgical excision of Tenon's capsule cysts, was significantly higher in fellow eyes than in first eyes (16 vs. 6 cases; P = 0.03; Mann-Whitney U test). Hypotony as a complication occurred more frequently in fellow eyes. CONCLUSIONS: Primary trabeculectomies performed in both eyes of patients have a remarkably similar clinical course. Failures of first eyes may be a reason to use antimetabolites in primary trabeculectomy of the fellow eye. The present data suggest that fellow eyes have a greater risk of Tenon's capsule cyst formation. This may be important for patient counseling before surgery. These results may additionally be important for clinical studies. Given that first and fellow eyes do not behave in an absolutely similar manner, study designs making intraindividual comparisons may not be feasible.

Adolescent↗
PubMed2003

Viscocanalostomy versus trabeculectomy in white adults affected by open-angle glaucoma: a 2-year randomized, controlled trial.

PURPOSE: To compare the effectiveness and safety of viscocanalostomy and trabeculectomy in adults with uncontrolled open-angle glaucoma. DESIGN: Single-masked, parallel-group, prospective, randomized 24-month trial, with 90% power to detect a clinically important difference between groups. PARTICIPANTS: Fifty consecutive patients (50 eyes) with primary open-angle or pseudoexfoliative glaucoma. INTERVENTION: Eyes were assigned randomly to either viscocanalostomy (group 1) or trabeculectomy (group 2) with no intraoperative antifibrotics in the study eye. In group 1, no further intervention was allowed, whereas trabeculectomy eyes could receive subconjunctival 5-fluorouracil (5-FU) injections or laser suture lysis after surgery. MAIN OUTCOME MEASURES: Success rate based on intraocular pressure (IOP), visual acuity, discomfort, and other complications. RESULTS: At the end of the 24-month follow-up, IOP of 21 mmHg or less and more than 6 mmHg was achieved in 76% in group 1 (n = 19) and in 80% in group 2 (n = 20; log-rank P = 0.60); an IOP between 6 and 16 mmHg was obtained in 56% in group 1 (n = 14) and in 72% in group 2 (n = 18; log-rank P = 0.17; Kaplan-Meier cumulative probability of success). Complications of viscocanalostomy included one intraoperative conversion into trabeculectomy; microruptures in Descemet's membrane in five eyes; three cases of iris incarceration in the Decemet's window, two of which caused early failure of the procedure requiring reoperation; and a 1-mm to 2-mm transient self-resolving hyphema in three cases. Complications of trabeculectomy included one case of postoperative bleb bleeding with early transient IOP spike; one early hyphema; five cases of postoperative hypotony, two of which had a positive Seidel test from the conjunctival suture; three cases of transient choroidal detachment, two of which had shallow anterior chamber. No patient required reoperation. Two eyes required argon laser suture lysis, and nine underwent one or more 5-FU injections, which caused punctate keratopathy in three eyes. CONCLUSIONS: Viscocanalostomy is an effective IOP-lowering procedure in white adults affected by open-angle glaucoma. Trabeculectomy with postoperative 5-FU can probably provides lower IOPs but, with more numerous complications, greater discomfort, and more intensive postoperative management.

Aged↗
PubMed1988

Laser suture lysis after trabeculectomy.

In an effort to achieve the early postoperative safety and stability provided by trabeculectomy plus the late lower intraocular pressure (IOP) advantages of full-thickness glaucoma filtration surgery, 43 eyes of 38 patients with chronic open-angle glaucoma had laser suture lysis after primary trabeculectomy. The technique of laser suture lysis afforded serial release of resistance to aqueous outflow through the newly performed trabeculectomy, allowing initial tight closure of the trabeculectomy to avoid the dangers of hypotony. Serial gradual loosening of the trabeculectomy closure decreased resistance to outflow through the trabeculectomy and thereby lowered the IOP to desired levels in a controlled, titrated manner. Complications decreased with experience. For 25 eyes with at least 6 months follow-up (average, 54 weeks), the average IOP decreased from 25.0 mmHg preoperatively to 12.2 mmHg postoperatively.

Aged↗
PubMed2000

Outcome of trabeculectomy with mitomycin-C in the iridocorneal endothelial syndrome.

PURPOSE: Eyes with iridocorneal endothelial (ICE) syndrome have a high risk of failure in glaucoma filtering surgery failing. We investigated the efficacy of trabeculectomy with intraoperative mitomycin-C application in these patients. DESIGN: Retrospective nonrandomized comparative trial with historical controls. PARTICIPANTS AND CONTROLS: Ten patients with unilateral iridocorneal endothelial (ICE) syndrome were reviewed. Their intraocular pressures could not be controlled medically. In five eyes, this was the primary surgery performed. Five of the patients had undergone prior intraocular pressure-(IOP) lowering surgery that had failed at the time enrolled. Results were compared with previously published case series of similar patients treated with trabeculectomy alone or trabeculectomy and subconjunctival 5-fluorouracil injections. INTERVENTION: Intervention consisted of trabeculectomy with a limbus-based conjunctival flap and mitomycin-C application. The dosage of mitomycin-C was 0.4 mg/ml for 1 to 4 minutes (mean, 1.9 min). MAIN OUTCOME MEASURES: Adequate control of IOP (without medication lower than 21 mm Hg). RESULTS: In eight eyes the IOP remained well controlled (mean IOP, 12.1 mm Hg) over the entire length of available of follow-up (mean, 14.9 months). Two eyes required implantation of an aqueous tube shunt at 4 and 11 months, respectively, after trabeculectomy with mitomycin-C. One eye experienced visual loss of 3 Snellen lines because of hypotony maculopathy. CONCLUSIONS: Trabeculectomy with mitomycin-C application offers a reasonable intermediate-term success rate in ICE patients, who are otherwise at high risk for failure of filtering surgery.

Adult↗
PubMed1999

Otago glaucoma surgery outcome study: long-term results of trabeculectomy--1976 to 1995.

OBJECTIVE: To provide data on the long-term results of trabeculectomy performed in the province of Otago, New Zealand. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 289 eyes of 193 patients (excluding 4 eyes lost to follow-up soon after operation); all trabeculectomies performed for the first time on cases of primary glaucoma from 1976 through 1995. INTERVENTION: Standard Cairns trabeculectomy. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, visual field damage. RESULTS: Trabeculectomy was effective in controlling intraocular pressure at a level of 21 mmHg or less, with probabilities of 0.93 (95% confidence interval [CI], 0.90-0.97), 0.87 (95% CI, 0.82-0.93), and 0.85 (95% CI, 0.77-0.92) at 5, 10, and 15 years, respectively, after surgery. The mean visual acuity improved from 20/60 to 20/40 immediately after trabeculectomy but then declined steadily over the postoperative years. The decline in visual acuity led to blindness in 47 eyes. The Kaplan-Meier estimated probability of retaining useful vision (visual acuity > 20/400 and visual field > 5 degrees radius) in the overall group was 0.87 (95% CI, 0.79-0.91), 0.72 (95% CI, 0.60-0.79), and 0.6 (95% CI, 0.43-0.69) at 5, 10, and 15 years, respectively, after surgery. Those eyes that had good preoperative visual acuity (visual acuity > or = 20/30) had a significantly better chance of retaining useful vision (P = 0.02). CONCLUSIONS: The intraocular pressure was well controlled by trabeculectomy, but a steady long-term decline in visual acuity and visual field occurred, decreasing the probability of an eye retaining useful vision up to the time of death to approximately 0.6.

Adult↗
PubMed1999

The National Survey of Trabeculectomy. I. Sample and methods.

PURPOSE: The National Survey of Trabeculectomy was designed to evaluate current practices of glaucoma surgery in the United Kingdom and to determine the success and complication rates of trabeculectomy on a national basis. This paper reports the survey methods, levels of consultant activity, waiting times, indications for surgery and the demographic and clinical characteristics of the patient sample. METHODS: Consultant ophthalmologists performing trabeculectomy in the United Kingdom were studied. Four consecutive patients undergoing trabeculectomy under each consultant prior to 18 June 1996 were retrospectively sampled. Patients were followed prospectively and evaluated 6 and 12 months after surgery. Data were collected by self-administered postal questionnaires. To determine the effects of selection and reporting bias a validation study of 14 randomly selected units was also conducted. RESULTS: Three hundred and eighty-two consultants recruited 1454 eligible patients for analysis. The mean age of patients was 69.2 years (standard deviation 10.9) and 51.7% were male. The underlying diagnosis was primary open angle glaucoma in 89.2%, pseudoexfoliation glaucoma in 5.4%, normal tension glaucoma in 3.8% and pigmentary glaucoma in 1.6%. There was advanced visual field damage in 50.5% of the cohort by the time of listing. The main indications for surgery were failure of medication to control intraocular pressure in 57.1%, progressive visual field loss in 26.5% and progressive optic disc damage in 4.8%. Primary surgery was undertaken in 4.8% of patients. In 80% trabeculectomy was performed within 3 months of listing. However, almost a third of consultants considered individual patient's waiting time too long. Validation studies confirmed that systematic bias did not operate in the selection of patients for the survey or in the reporting of outcomes. CONCLUSION: The findings of this survey are representative of current practices of trabeculectomy by consultants throughout the United Kingdom and show considerable variation in practice. Failure to control intraocular pressure with topical medications was the main indication for surgery. Advanced glaucomatous visual field damage was present at the time of surgery in half the sample. Though most patients were operated on within 3 months of listing, almost a third of consultants considered the wait unacceptably long.

Age Factors↗
PubMed2006

The effect of aspirin and warfarin therapy in trabeculectomy.

AIM: The management of patients on antiplatelet and anticoagulation therapy (APACT) in glaucoma surgery currently has no specific recommendations. We aimed to establish the risk of haemorrhagic complications and surgical outcome in patients on APACT in glaucoma surgery. METHODS: We retrospectively examined 367 consecutive trabeculectomies performed between 1994 and 1998. Preoperatively 60 (16.4%) patients were on APACT (55 on aspirin and five on warfarin). The incidence of hyphaema and haemorrhagic complications between patients with and without APACT was documented. Surgical success was defined in two categories as an intraocular pressure (IOP) <21 mmHg and an IOP <16 mmHg 2 years following trabeculectomy with and without antiglaucoma medication. RESULTS: None of the patients on aspirin suffered significant intra or postoperative haemorrhage. Aspirin was associated with a significantly higher risk of hyphaema (P=0.0015) but this was not found to significantly affect IOP control at 2 years. Patients on warfarin suffered haemorrhagic complications and trabeculectomy failure. CONCLUSIONS: Aspirin appears to be safe to continue with during trabeculectomy. Patients on aspirin have an increased risk of hyphaema following trabeculectomy. This however does not appear to affect surgical outcome. Warfarinised patients are at risk of serious bleeding complications. They require careful monitoring pre- and postoperatively and are at risk of trabeculectomy failure.

Adolescent↗
PubMed1999

Does trabeculectomy influence the course of uveitis?

It was our clinical impression that patients with uveitis who had undergone trabeculectomy had an improvement in their intraocular inflammation following surgery. We undertook a retrospective review of the notes of all patients who underwent unaugmented trabeculectomy for uncontrolled intraocular pressure secondary to uveitis between September 1990-July 1994, at the Uveitis Service of the Birmingham and Midland Eye Centre, UK. The severity of the inflammation and the number of relapses post-trabeculectomy were compared to those during the pre-trabeculectomy period. A total of 32 eyes of 20 patients with various types of uveitis were included in the study. Mean age was 40 years (SD+/-2.5), range: 14-67 years, median follow-up of 53 months (SE+/-1.8), range: 33-84 months. An improvement in the pattern of uveitis post-trabeculectomy, defined as reduction in the severity of the inflammation and the number of relapses, was seen in 23 out of 32 (71.9%) eyes. Furthermore, five out of 15 patients in this group had either their systemic treatment stopped or the number of systemic agents reduced. Another five eyes (15.6%) showed no change in the pattern of uveitis. The remaining four eyes (12.5%) suffered an increase in the number of relapses or increased severity of inflammation requiring additional treatment. It appears that trabeculectomy may have a beneficial effect on the course of uveitis. The mechanism for this is not clear.

Adult↗
PubMed2001

Trabeculectomy combined with phacoemulsification and intraocular lens implantation.

It has recently become popular to use mitomycin C (MMC) with trabeculectomy. MMC helps to maintain effective filtration and long-term intraocular pressure (IOP) control, while the use of laser suture lysis has improved the safety of this procedure. We evaluated the outcome of trabeculectomy alone and of trabeculectomy plus phacoemulsification (PEA) and intraocular lens (IOL) implantation, each supplemented with MMC. The mean preoperative IOP for the trabeculectomy alone group was 22.4 +/- 3.2 mmHg(bleb+), 25.3 +/- 2.6 mmHg(bleb-), and that of the combined surgery group was 22.4 +/- 2.8 mmHg(bleb+), 21.0 +/- 3.5 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.3 +/- 2.7 mmHg(bleb+), 17.1 +/- 4.4 mmHg(bleb-) and 11.9 +/- 2.7 mmHg(bleb+), 16.4 +/- 3.4 mmHg(bleb-), respectively. After 4.5 years, the success probability for postoperative IOP control was 38%(bleb+), 3%(bleb-) in the trabeculectomy alone group and 53%(bleb+), 10%(bleb-) in the combined surgery group (<or=12 mmHg) and 65%(bleb+), 3%(bleb-) and 75%(bleb+), 10%(bleb-) (<or=14 mmHg)(Kaplan-Meier survival rate). With early complications, the frequency of shallow anterior chamber and choroidal detachment were significantly fewer in the combined surgery group. The combined surgery of PEA, IOL implantation and trabeculectomy is an effective procedure that offers visual rehabilitation, fewer early complications and good IOP control in patients with advanced, medically uncontrolled glaucoma and cataract.

Cataract↗