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PubMed1985

Trabeculectomy: a prospective study of complications and results of long-term follow-up.

A total of 50 trabeculectomies were carried out with pre- and postoperative medications using steroids and indomethacin, and also with the use of sodium hyaluronate during surgery. The postoperative course was followed by the prospective study protocol adopted by Shirato et al and the results were compared with the Shirato series of 145 trabeculectomies where the surgery was performed without the above medications and without the use of sodium hyaluronate. The shallow anterior chamber and choroidal detachment were less frequent, and the complication-free postoperative course was more frequent in the present than in the Shirato series. The state of the intraocular pressure control of the Shirato series was analyzed by the life-table method for the follow-up period of about 5 years. The final success rate in maintaining the intraocular pressure at or below 20 mmHg after the first trabeculectomy was 60.8 +/- 7.2 (SE) % in primary open-angle glaucoma, 64.2 +/- 12.1% in primary angle-closure glaucoma and 31.1 +/- 9.9% in secondary glaucoma. There were several cases where argon laser trabeculoplasty had been carried out before trabeculectomy. The success rate in these cases appeared to be no different from the rate in the rest of the eyes. In primary open-angle glaucoma, the second surgery after failed first trabeculectomy gave a similar success rate as the first surgery, but the third surgery after two failed trabeculectomies gave a very low success rate. The intraocular pressure distribution after one year showed a frequency of visual field deterioration was high in the order of the eyes with the intraocular pressure higher than 20 mmHg, those with 15-20 mmHg and those with lower than 15 mmHg.

Actuarial Analysis↗
PubMed1998

Trabeculectomy with releasable sutures: a prospective, randomized pilot study.

OBJECTIVE: To compare the short-term and long-term efficacy of using releasable sutures vs conventional interrupted sutures for scleral flap suturing in trabeculectomy. DESIGN: A prospective randomized study. SETTING: A university-affiliated referral eye hospital. PATIENTS: Thirty consecutive patients requiring trabeculectomy for uncontrolled primary glaucoma. INTERVENTION: Fifteen patients underwent trabeculectomy with permanent interrupted sutures; the same number underwent trabeculectomy with releasable sutures. MAIN OUTCOME MEASURES: Incidence of short-term shallowing of anterior chamber or hypotony and related complications, and long-term intraocular pressure control and bleb score. RESULTS: The mean percentage reduction in intraocular pressure on day 1 in the group with releasable sutures was 55.2%, while only a 0.8% reduction in anterior chamber depth was noted. This compared with figures of 59.3% and 10.1%, respectively, in the group without releasable sutures. Hypotony (intraocular pressure < or =6 mm Hg) was noted in 8 (53%) of cases without releasable sutures and 3 (20%) of cases with releasable sutures. Shallow anterior chamber (central anterior chamber depth, < or =1 mm) was noted in 5 (33%) of cases without releasable sutures and 1 (7%) of cases with releasable sutures. The mean +/- SD final bleb score was 5.4 +/- 0.3 in the group with releasable sutures compared with 4.2 +/- 0.6 in the group without releasable sutures (P<.001). The mean +/- SD final intraocular pressure at the end of 12 months was 16.9 +/- 1.2 mm Hg in the group without releasable sutures and 15.0 +/- 0.9 mm Hg in the group with releasable sutures (P<.001). Final intraocular pressure was controlled (intraocular pressure < or =21 mm Hg) in all patients in the group with releasable sutures, giving a success rate of 100%, and in 12 patients in the group without releasable sutures, giving a success rate of 80%. CONCLUSIONS: Use of releasable sutures is an effective way at no extra cost or instrumentation to maximize the long-term bleb score and lower intraocular pressure, and to minimize the short-term complications of trabeculectomy.

Anterior Chamber↗
PubMed1990

The influence of prior therapy on the success of trabeculectomy.

The role of early surgery in the management of primary open angle glaucoma is under debate. To determine whether previous medical therapy influences the outcome of subsequent trabeculectomy, we retrospectively reviewed the results of surgery in two groups of patients. The first group underwent primary trabeculectomy, having had an average of 2 weeks of preoperative medical therapy, and this group was compared with a group of patients who had received at least 1 year of topical glaucoma therapy before undergoing trabeculectomy (the multiple-treatment group). The two groups were similar in terms of a number of variables, including race, age, sex, presenting intraocular pressures, and presenting visual fields, and they differed only in the known duration of their disease. The success rate of trabeculectomy was significantly higher in the primary trabeculectomy group as compared with that in the multiple-treatment group (P less than .001). We discuss the possible reasons for this difference and its implications for the future management of primary open angle glaucoma.

Aged↗
PubMed1989

Effect of postoperative subconjunctival 5-fluorouracil injections on the surgical outcome of trabeculectomy in the Japanese.

A controlled study was carried out to evaluate the effect of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcomes of trabeculectomy in the Japanese (a total of 196 eyes in 157 patients). The eyes that had undergone trabeculectomy with postoperative 5-FU (5-FU group) included 36 eyes with primary open-angle glaucoma (POAG) and 17 with secondary glaucoma (SG) undergoing their first or second trabeculectomy. There were also 34 eyes with refractory glaucoma. The eyes that had had trabeculectomy without postoperative 5-FU (control group) included 46 POAG and 31 SG eyes undergoing their first or second trabeculectomy and 24 refractory glaucoma eyes. The surgical techniques and postoperative care were virtually identical between the two groups, except that the control group did not receive 5-FU. The results were analyzed by means of a life table method and a postoperative intraocular pressure (IOP) level equal to or less than 20 mmHg was adopted as the criterion for successful IOP control. In the 5-FU group, the success probability (%) at the 3-year follow-up was 93.9 +/- 4.2 (SE) for POAG eyes, 93.8 +/- 6.1 for SG eyes, and 86.7 +/- 5.6 for refractory glaucoma eyes. In the control group, it was 55.0 +/- 7.9, 37.2 +/- 13.5, and 16.1 +/- 7.4, respectively. The difference in success probability between the 5-FU and control groups was highly significant (P less than 0.001 or 0.01). In the POAG and SG eyes, the mean postoperative IOP was significantly lower in the 5-FU group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

5-Fluorouracil for trabeculectomy in glaucoma.

The effect of 5-fluorouracil (5-FU) subconjunctival injection on the bleb formation and intraocular pressure (IOP) following trabeculectomy was studied in 18 glaucoma patients (20 eyes) with poor surgical prognosis. The results were analyzed by means of life tables and compared with those of 24 glaucoma eyes that had undergone trabeculectomy without postoperative administration of 5-FU after a previous repeat trabeculectomy that had failed. The surgical techniques and postoperative care were virtually identical between the eyes treated with 5-FU and eyes that had undergone repeat trabeculectomy, except that the latter group did not receive 5-FU postoperatively. At the end of 18-month follow-up, the success probability was 68.2% in the 5-FU treated eyes, and it was already as low as 10% in the nontreated eyes at the end of the 14-month follow-up. The difference was statistically highly significant (P less than 0.001). Postoperative, subconjunctival injection of 5-FU appears to improve the prognosis following trabeculectomy in patients with a poor surgical prognosis.

Cicatrix↗
PubMed2004

[Deep sclerectomy using a hyaluronate implant versus trabeculectomy. A comparison of two glaucoma operations using mitomycin C].

BACKGROUND: It was investigated whether a very low target pressure could be achieved by modification of deep sclerectomy without losing the advantages of non penetrating surgery in comparison to conventional filtration surgery. PATIENTS AND METHODS: A total of 22 eyes from 22 patients with advanced open angle glaucoma were randomly assigned to receive a deep sclerectomy or a trabeculectomy. Both groups received 0.02% mitomycin C under the conjunctiva prior to preparation of the scleral flap. In the deep sclerectomy group at least parts of the outer trabecular meshwork were removed until an apparent filtration was achieved. A dry cross-linked hyaluronate served as an implant. In the other group a classical trabeculectomy was performed. RESULTS: The median intraocular pressure 12 months post-operation was 11.5 mm Hg in the deep sclerectomy group compared to 11 mm Hg in the trabeculectomy group; the median of the relative IOP reduction was -47% in the deep sclerectomy group, and -57% in the trabeculectomy group. The best corrected visual acuity was unchanged 12 months postoperatively in both groups. DISCUSSION: As a more aggressive IOP-lowering procedure (intended filtration, use of antimetabolites) deep sclerectomy proved to be as effective as trabeculectomy. Nevertheless, the advantages of the more difficult surgical procedure concerning visual acuity, complications and surgical interventions were lost postoperatively.

Adult↗
PubMed1998

[Ab externo erbium YAG laser sclerostomy versus conventional trabeculectomy. Treatment of glaucoma patients].

PURPOSE: This study was conducted to compare the efficacy of the Er-YAG laser sclerostomy ab externo versus trabeculectomy in the treatment of primary open-angle glaucoma. METHODS: Twelve patients with POAG underwent ab externo laser sclerostomy using an Er-YAG laser (Sklerostom 2.9; lambda = 2940 nm, t = 200 microseconds, 2 Hz, 400 microns, 15 mJ). Only local medication was used, and there were no risk factors for failure. As a control group 12 patients out of 248 standardized trabeculectomies were matched in terms of age, sex, diagnosis and local medications. No antimetabolites were used in either group. RESULTS: After a follow-up of 9 months in the sclerostomy group 53%; (7/12; P = 0.03) showed a patent fistula in comparison of 100% in the trabeculectomy group. There was a significantly lower mean IOP during the first postsurgical week in the group of sclerostomies (3.6 +/- 1.5 mmHg versus 7.5 +/- 2.7 mmHg; P = 0.0001) with a higher incidence of choroidal detachments (9/12 versus 2/12; P = 0.004). The choroidal detachments lasted longer in the sclerostomy group (3.5 months versus 0.3 months; P = 0.014). Iris incarcerations were found only in sclerostomies (7/12; P = 0.05). CONCLUSIONS: Based on these findings, Er-YAG laser sclerostomy prooved to be less effective than trabeculectomy in the treatment of glaucoma patients. Er-YAG laser sclerostomies were associated with a higher incidence of postsurgical complications such as hypotony, choroidal detachments and iris incarcerations. At this point Er-YAG laser sclerostomy is not superior to conventional trabeculectomy.

Aged↗
PubMed2003

Five-year results of trabeculectomy with mitomycin C.

BACKGROUND: The long-term efficacy and safety of primary trabeculectomy with mitomycin C were retrospectively studied. METHODS: Sixty eyes of 60 patients with severe glaucoma, 25 female and 35 male, with a mean age of 72.5 years who underwent primary trabeculectomy with mitomycin C between 1993 and 1995 were included. Glaucoma subtypes consisted of 42 patients with primary open-angle glaucoma, 10 patients with normal-pressure glaucoma, 2 patients with chronic narrow-angle glaucoma, 5 patients with pigment dispersion syndrome and 1 patient with pseudoexfoliation syndrome. During surgery, mitomycin C 0.2 mg/ml was applied under the scleral flap for 3 min. RESULTS: Mean intraocular pressure (IOP) decreased from 22.3+/-9.3 preoperatively to 12.6+/-3.5 mmHg postoperatively. With success defined as an IOP level of 15 mmHg or less, a success rate of 83.3% was obtained in the 1st year, dropping to 60% in the 6th year following trabeculectomy. Visual fields remained stable in 73.3% of cases during the follow-up period. LogMAR visual acuity increased from 0.2 to 0.4. Four eyes underwent cataract surgery prior to trabeculectomy. Thirteen eyes underwent cataract surgery during the follow-up period. Long-term complications were relatively mild and consisted of two cases of blebitis. Bleb reconstruction was performed in five eyes with overfiltration or bleb-related complaints. CONCLUSIONS: The present findings indicate that the additional use of mitomycin C may be justified in trabeculectomies in patients with severe glaucoma.

Aged↗
PubMed2004

Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy.

PURPOSE: To compare surgically induced corneal refractive change following trabeculectomy with the nonpenetrating trabecular filtering surgeries with and without implant. SETTING: Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey. METHODS: A consecutive series of 34 patients (34 eyes) with uncontrolled open-angle glaucoma had trabecular filtering surgery. Patients were assigned randomly to receive viscocanalostomy (12 patients), nonpenetrating deep sclerectomy (NPDS) with T-flux implant (10 patients), and trabeculectomy (12 patients). Autokeratometry and computerized corneal videokeratoscopy with the Topcon KR-7000P autokeratorefractometer were performed preoperatively and 1 day and 1, 3, and 6 months postoperatively to analyze surgically induced keratometric and topographic astigmatism. RESULTS: Thirty patients (11 trabeculectomy, 11 viscocanalostomy, and 8 NPDS with nonabsorbable implant) completed the study. Mean patient age was 61.7 years +/- 10.9 (SD) (range 37 to 81) and did not differ among groups. Postoperative intraocular pressure (IOP) levels and visual acuity (logMAR values) did not differ among groups compared with preoperative levels. Average induced astigmatism was lower in the NPDS group than the trabeculectomy group at postoperative month 3 and 6 based on autokeratometry values (P =.023 and.042, respectively). Nonpenetrating surgeries resulted in less induced astigmatism in the early postoperative period and less against-the-rule shift over 6 months. CONCLUSION: Despite larger flap size and surgical area, nonpenetrating trabecular surgeries induced less astigmatism than trabeculectomy.

Adult↗
PubMed2004

Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite.

OBJECTIVE: To evaluate the effect of temporal corneal phacoemulsification on intraocular pressure (IOP) in eyes after primary trabeculectomy with intraoperative fluorouracil (5-FU) or mitomycin C (MMC). DESIGN: Retrospective case-control study. PATIENTS: Twenty-nine patients who were participants in a prospective randomized double-masked trial comparing the efficacies of intraoperative 5-FU and MMC and who underwent temporal corneal phacoemulsification after the primary trabeculectomy were matched to 29 patients enrolled in the same study who did not undergo cataract surgery. The 2 groups were matched for length of follow-up after the trabeculectomy and the antimetabolite used at the time of trabeculectomy. METHODS: Comparisons of IOP, visual acuity (VA), and the number of glaucoma medications were made between the 2 groups and within the groups at various follow-up intervals to detect any statistically significant differences. MAIN OUTCOME MEASURES: Intraocular pressure before phacoemulsification and at various times postoperatively were compared with IOP in the control group at the matched follow-up times. RESULTS: The mean of all IOP measurements beyond 3 months after phacoemulsification for each subject was significantly higher than the prephacoemulsification IOP (11.8+/-4.2 vs. 8.7+/-4.5 mmHg; P = 0.00003, paired t test). In contrast, the mean IOP remained stable in the control group during the equivalent time period (9.6+/-3.5 vs. 9.1+/-3.1 mmHg; P = 0.42, paired t test). Postphacoemulsification IOP was significantly higher than the corresponding IOP in the time-matched control group (P<0.003, analysis of covariance). Mean VA improved significantly after the phacoemulsification (P = 0.0002) but remained stable in the control group. CONCLUSION: Temporal corneal phacoemulsification can affect long-term IOP control after trabeculectomy with 5-FU or MMC.

Adult↗
PubMed2001

Mini-trabeculectomy as initial surgery for medically uncontrolled glaucoma.

PURPOSE: To report on the surgical outcome after at least 12 months of follow-up of mini-trabeculectomy (without radial incisions) as an initial surgery. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed as the initial surgical therapy on 41 eyes with medically uncontrolled glaucoma of 41 consecutive patients aged 40 years or older. Mini-trabeculectomy consists of a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. Of the 41 eyes, four eyes did not complete 12 months of follow-up. Of the remaining 37 eyes, one eye underwent cataract extraction 5 months postoperatively and was evaluated only for surgical complications. Thirty-six patients with a mean age of 70.3 +/- 7.4 standard deviation years (range, 54 to 87) completed 12 months or more of follow-up. RESULTS: In the 36 eyes, mean preoperative intraocular pressure was 30.2 +/- 9.3 mm Hg (range, 19 to 54) with 3.0 +/- 1.2 hypotensive medications (range, 1 to 4). After postoperative mean follow-up of 25.0 +/- 9.2 months (range, 12 to 43), intraocular pressure was at or below the planned target intraocular pressure in 35 eyes (97.2%; P <.0001) and mean intraocular pressure was 16.0 +/- 2.8 mm Hg (range, 11 to 21) with 0.8 +/- 1.0 medications (range, 0 to 3). Postoperative complications in the 37 eyes included early postoperative aqueous leakage with moderately shallow or deep anterior chamber in two eyes (5.4%) and rapid cataract progression in one eye (2.7%). The four eyes that were excluded from the study had intraocular pressures of 10 to 16 mm Hg with 0 to 1 hypotensive medications, 3 to 9 months after surgery, respectively. CONCLUSIONS: Mini-trabeculectomy, which may offer clinical and technical advantages over the standard trabeculectomy, was generally efficacious and relatively safe, based on outcome observed at a mean of 25 months follow-up. A controlled study is required to confirm these observations.

Aged↗
PubMed1996

Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C.

PURPOSE: To report the incidence of failing filtration blebs after trabeculectomy with mitomycin C and to report the outcome of needling procedures for failing filtration blebs in these eyes. METHODS: We conducted a retrospective analysis of 537 eyes of 434 patients who had trabeculectomy with mitomycin C and reviewed the clinical course of 441 eyes of 338 patients with a minimum of three months of follow-up. RESULTS: In 441 eyes of 338 patients followed up for three months or more after trabeculectomy with mitomycin C, 88 (20.0%) eyes from 85 patients underwent needle elevation of the scleral flap. Forty-nine (22.4%) of 219 eyes required needle revision after trabeculectomy alone, and 39 (17.6%) of 222 eyes after trabeculectomy combined with cataract extraction and intraocular lens implantation. Mean intraocular pressure (IOP) after needle revision (17.9 +/- 11.6 mm Hg) was significantly less than the mean preneedling IOP (27.1 +/- 10.4 mm Hg, P < .00001, paired Student's t test). Sixty-three eyes of 60 patients had a minimum of three months of postneedling follow-up. Successful pressure control, defined as an IOP of 22 mm Hg or less with or without topical glaucoma control medications, was achieved in 46 (73.0%) of 63 eyes. Unsuccessful outcomes correlated significantly with higher preneedling IOP (R = 0.28, P = .03, df = 61) and prior surgery involving conjunctival incisions (R = 0.53, P < .00001, df = 61). CONCLUSIONS: Needle elevation of the scleral flap may provide significantly long-lasting pressure reduction in eyes with failing mitomycin C blebs. Higher success rates are achieved in eyes with fewer prior conjunctival incisions, eyes requiring a single needle revision, and eyes with lower preneedling IOP.

Adult↗
PubMed1999

The Advanced Glaucoma Intervention Study (AGIS): 5. Encapsulated bleb after initial trabeculectomy.

PURPOSE: To compare the incidence of encapsulated bleb after trabeculectomy in eyes with and without previous argon laser trabeculoplasty and to assess other risk factors for encapsulated bleb development. METHODS: After medical treatment failure, eyes enrolled in the Advanced Glaucoma Intervention Study (AGIS) were randomly assigned to sequences of interventions starting with either argon laser trabeculoplasty or trabeculectomy. In the present study we compared the clinical course for 1 year after trabeculectomy in 119 eyes with failed argon laser trabeculoplasty with that of 379 eyes without previous argon laser trabeculoplasty. Data on bleb encapsulation were collected at the time that the encapsulation was diagnosed, and 3 and 6 months later. RESULTS: Of multiple factors examined in the AGIS data for the risk of developing encapsulated bleb, only male gender and high school graduation without further formal education were statistically significant. Encapsulation occurred in 18.5% of eyes with previous argon laser trabeculoplasty failure and 14.5% of eyes without previous argon laser trabeculoplasty (unadjusted relative risk, 1.27; 95% confidence limits = 0.81, 2.00; P = .23). After adjusting for age, gender, educational achievement, prescribed systemic beta-blockers, diabetes, visual field score, and years since glaucoma diagnosis, this difference remains statistically not significant. Four weeks after trabeculectomy, mean intraocular pressure was 7.5 mm Hg higher in eyes with (22.5 mm Hg) than without (15.0 mm Hg) encapsulated bleb; at 1 year after trabeculectomy and the resumption of medical therapy when needed, this excess was reduced to 1.4 mm Hg. CONCLUSIONS: This study, as did two previous studies, found male gender to be a risk factor for bleb encapsulation. Four studies, including the present study, have reported a higher rate of encapsulation in eyes with previous argon laser trabeculoplasty; in two of the studies, one of which was the present study, the rate was not statistically significantly higher; in the other two studies the rate was significantly higher. The 4-week postoperative mean intraocular pressure was higher in eyes with than without encapsulated bleb; with the resumption of medical treatment the two means converged after 1 year.

Aged↗
PubMed2001

Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: A randomized clinical trial.

PURPOSE: To compare viscocanalostomy, a nonpenetrating procedure for glaucoma treatment, with trabeculectomy. DESIGN: Randomized controlled trial. PARTICIPANTS: Twenty white subjects (20 eyes) with open-angle glaucoma with no history of surgery were enrolled. METHODS: Ten subjects were randomly assigned to viscocanalostomy according to Stegmann's technique and 10 subjects to a modified Cairns trabeculectomy. A complete ophthalmologic examination was performed the day before surgery and postoperatively. Further visits were scheduled monthly for 6 to 8 months after surgery. MAIN OUTCOME MEASURES: Success was defined as intraocular pressure (IOP) between 7 and 20 mmHg, with no medication. RESULTS: After a mean follow-up of 6 months (range, 6-8 months), success was obtained in 5 of 10 cases in the trabeculectomy group and in no case in the viscocanalostomy group. With Kaplan-Meier's method, subjects with viscocanalostomy showed shorter postoperative IOP-reduction periods than subjects undergoing trabeculectomy. CONCLUSIONS: According to the results of this short-term study, trabeculectomy was more effective than viscocanalostomy in lowering IOP in glaucomatous eyes of white patients.

Adult↗
PubMed2001

Optic nerve head circulation after intraocular pressure reduction achieved by trabeculectomy.

OBJECTIVE: To study the effects of trabeculectomy and needling revision of poorly functioning blebs on the optic nerve head (ONH) circulation in patients with primary open-angle glaucoma (POAG). DESIGN: Prospective, nonrandomized, self-controlled trial. PARTICIPANTS: Nineteen POAG patients (age range, 52 +/- 12 years; mean +/- standard deviation) undergoing trabeculectomy and six POAG patients (age range, 62 +/- 14 years) undergoing needling revision of the bleb. METHODS: Using the laser speckle method, the normalized blur (NB) value, a quantitative index of blood velocity, was determined every 0.125 seconds and averaged more than three cardiac pulses in the optic nerve head (NB(ONH)). MAIN OUTCOME MEASURES: The NB(ONH) and intraocular pressure (IOP) in both eyes, and blood pressure (BP) and pulse rate (PR) were measured before and 2 days and 1, 4, and 8 weeks after trabeculectomy, and also before and 10 and 40 min after needling procedures. RESULTS: Intraocular pressure in the operated eye was significantly decreased after trabeculectomy or needling procedures, and the ocular perfusion pressure was significantly increased by a maximum of 38%. The IOP in the unoperated eye, BP, and PR did not significantly change. The NB(ONH) did not significantly change in either the operated or unoperated eye. CONCLUSIONS: Trabeculectomy and needling procedures induced little change in the ONH circulation.

Blood Circulation↗
PubMed1991

Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil.

The incidence of late-onset bleb-related endophthalmitis was evaluated retrospectively in 229 consecutive trabeculectomies performed with adjunctive 5-fluorouracil (5-FU) therapy. Mean follow-up was 23.7 +/- 16.3 months (range, 3 to 60 months). Thirteen eyes (5.7%) of 11 patients developed bleb-related endophthalmitis an average of 25.9 +/- 17.4 months (range, 5 to 58 months) after surgery. Infection occurred in 9 of 96 (9.4%) procedures performed from below and in 4 of 133 (3.0%) procedures performed superiorly (P = 0.05, Fisher's exact test). The relative risk of bleb-related endophthalmitis in trabeculectomy from below versus above is 4.0 after adjustment for age and sex (95% confidence interval = 1.1, 14.8). Trabeculectomy with adjunctive 5-FU performed from below carries an increased risk of late bleb-related infection. The incidence of late bleb-related endophthalmitis after 5-FU trabeculectomy appears to be higher than that for trabeculectomy without adjunctive 5-FU injections.

Adolescent↗
PubMed1993

Primary trabeculectomy in young adults.

BACKGROUND: Younger patients are thought to have a poor surgical prognosis after trabeculectomy. The authors investigate the surgical outcome of young adult patients after primary trabeculectomy. METHODS: The authors reviewed the charts of all patients 15 to 40 years of age who had undergone primary trabeculectomy without the use of antimetabolites between January 1985 and January 1992 at Wills Eye Hospital. Failure was defined before the data collection as intraocular pressure (IOP) more than 25 mmHg without medication, IOP more than 21 mmHg with medication, or when further glaucoma surgery was indicated. Patients in whom preoperative IOPs were 21 mmHg or lower were classified as successes when the IOP was reduced by at least 33% of the preoperative measurement. RESULTS: After a mean follow-up of 36.8 +/- 21.8 months, among the 31 patients with uncomplicated glaucomas (juvenile, pigmentary, low tension, chronic angle closure), 26 (83.9%) were considered successes. After a mean follow-up of 42.3 +/- 26.5 months, among the 11 patients with other types of glaucoma (inflammatory, traumatic, associated with irido-corneal endothelial syndrome or mesodermal dysgenesis), 7 (63.6%) were considered successes. CONCLUSIONS: The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older patients. Primary trabeculectomy in young adults may have a favorable outcome despite no antimetabolite therapy.

Adolescent↗
PubMed1993

Trabeculectomy and Molteno implantation for glaucomas associated with uveitis.

PURPOSE: This study compares the outcomes of trabeculectomy and Molteno implantation in the treatment of glaucomas associated with uveitis. METHODS: Forty-five patients with uveitis, who had undergone filtering surgery for glaucomas associated with uveitis, were reviewed retrospectively. Successful outcome was defined as final intraocular pressure (IOP) of 6 to 21 mmHg, with a minimum follow-up of 6 months without visually devastating complications or loss of light perception. RESULTS: One- and two-year life-table success rates, respectively, were 81% and 73% with trabeculectomy (16 patients); 53% and 31% with combined trabeculectomy and first-stage (reserve) Molteno implantation (19 patients); and 79% and 79% with one-stage Molteno implantation (10 patients). In 11 patients who underwent second-stage Molteno implantation after trabeculectomy failure, 1- and 2-year life-table success rates were 79% and 79%, respectively. Complications included surgically treated choroidal effusions (1/45; 2%), choroidal hemorrhages (3/45; 7%), and chronic hypotony (3/45; 7%). Follow-up in all groups ranged from 5 to 70 months (mean +/- standard deviation, 28 +/- 17 months). CONCLUSIONS: Trabeculectomy provides surprisingly good results in glaucomas associated with uveitis (modulation of wound healing with antimetabolites probably would afford an even higher success rate). However, when significant, immediate postoperative and/or moderate chronic postoperative inflammation is likely, aqueous drainage devices appear more likely to control IOP.

Adult↗