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PubMed2002

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Aged↗
PubMed1999

Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma.

PURPOSE: The purpose of this study was to evaluate mitomycin C-augmented trabeculectomy combined with postoperative subconjunctival 5-fluorouracil and laser suture lysis in the treatment of refractory pediatric glaucoma. METHODS: Twenty-one consecutive cases (17 patients) with refractory pediatric glaucoma treated with mitomycin C trabeculectomy (0.4 mg/mL for 3 to 5 minutes) and postoperative 5-fluorouracil, laser suture lysis, or both were retrospectively reviewed. Success was defined as intraocular pressure between 4 and 16 mm Hg without further glaucoma surgery or devastating complication. RESULTS: The median age of the study population was 2.6 years (range, 0.05 to 16 years). The overall success rate was 52.4%, with a median follow-up of 23 months for successful cases. Success rates for patients older than 1 year of age versus those younger than 1 year of age at surgery were 73% and 30%, respectively. Success rates for phakic versus aphakic eyes were 64% and 29%, respectively. Age and lens status, taken together, were significant predictors of outcome (P = .013). Reasons for failure in this study were uncontrolled intraocular pressure (8 cases), persistent wound leak (1 case), and endophthalmitis (1 case); the latter 2 cases required bleb excision. Other complications encountered included chorioretinal detachment, shallow anterior chamber, 5-fluorouracil toxicity, and cataract formation. No irreversible visual deficits could be attributed to the trabeculectomy procedure or subsequent complications in any of these cases. CONCLUSIONS: Mitomycin C-augmented trabeculectomy combined with postoperative suture lysis and 5-fluorouracil is a viable option for older phakic children with refractory glaucoma. This procedure has a lower success rate in infants and in aphakic eyes. Both early and late postoperative complications are common, and diligent lifelong long-term follow-up is needed to detect bleb leaks and infection. The addition of postoperative suture lysis and 5-fluorouracil to mitomycin C-augmented trabeculectomy did not provide any convincing improvement in the success of this procedure in pediatric patients with refractory glaucoma and may have increased the complication rate.

Adolescent↗
PubMed1991

Complications of 5--fluorouracil after trabeculectomy.

Trabeculectomy has a very high success rate, however, certain eyes are known to be at high risk of failure due to scarring of the conjunctival bleb. Such eyes include those with a previous failed filter, eyes with glaucoma secondary to uveitis and neovascularisation and the eyes of children and young adults. Trabeculectomy is generally accepted to have less successful results in patients of African race although good results are reported from some centres. The effectiveness of treatment with 5-fluorouracil in improving the results of trabeculectomy has been established in a number of pilot studies and clinical trials. Early studies used 100 mg of 5-fluorouracil in divided doses. Serious complications were recorded and lower dose regimes have been advised to improve the safety of the technique. Similar success in improving the chance of success to trabeculectomy has been found with doses of 40 mg with a lower incidence of side effects. We report complications associated with the use of 5-fluorouracil in a total dose of 50 mg in a group of 49 eyes undergoing trabeculectomy and postoperative 5-fluorouracil and describe the previously unreported increased incidence of thin cystic blebs in these eyes.

Adolescent↗
PubMed1993

Trabeculectomy: effect of varying surgical site.

Trabeculectomy reduces intraocular pressure by fistula formation into a subconjunctival bleb. The operation site traditionally has been at the superior corneo-scleral junction with a failure rate of 10-30%. The causes of trabeculectomy failure can be broadly classified into intraocular, scleral and extraocular. Extraocular factors account for the majority of failures, the main cause being increased subconjunctival fibrosis. Hitherto the effect of varying the site of filtration surgery on intraocular pressure control has not been studied. We therefore carried out a prospective study to evaluate the optimum site for trabeculectomy. Sixty patients were randomised to undergo a superior, nasal or temporal trabeculectomy. Patients who underwent a nasal trabeculectomy had significantly lower intraocular pressures 18 months after surgery (p < 0.05), with 30% having an intraocular pressure of < or = 10 mmHg.

Aged↗
PubMed2001

Non-penetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma surgery.

PURPOSE: To compare the intraocular pressure lowering effect and the frequency of post-operative complications in two of the most used filtration surgery techniques: trabeculectomy and non-penetrating deep sclerectomy (NPDS) without collagen implants. METHODS: Thirty-four eyes of 17 patients with medically uncontrolled symmetrical primary open-angle glaucoma were included in the study. One randomly selected eye per patient had either trabeculectomy or NPDS without collagen implants as the first surgical procedure. The other eye underwent the second filtration surgery technique less than 6 weeks later. Post-operatively, the intraocular pressure (IOP) diurnal curves were determined at 1, 2, 3, 6, 12 and 18 months. The intergroup differences in IOP lowering effect were determined in an analysis of covariance (ANCOVA), with pre-operative IOP as a changing covariate. Kaplan-Meier survival curves were drawn for IOP, and intercurve analysis was performed. Comparisons of the number of post-operative antiglaucomatous medications, as well as of the complication rate, were done by 2 x 2 frequency tables. A p value of less than 0.05 was considered statistically significant. RESULTS: There were statistically significant differences in post-operative IOP level between the two groups at 1, 2, 3, 6, 12 and 18 months, with a lower level in the trabeculectomy group. Using the Kaplan Meier cumulative survival curve, the trabeculectomy patients had a better complete success rate than the NPDS patients at 18 months post-operatively. There were statistically significantly fewer complications in the NPDS group. CONCLUSION: Trabeculectomy lowers the IOP more than the NPDS technique. However, the complication rate seems to be lower in NPDS.

Aged↗
PubMed2001

Trabeculectomy outcomes in advanced glaucoma in Nigeria.

BACKGROUND: Trabeculectomy remains the mainstay of therapy for advanced glaucoma in Nigeria due to the unavailability and expense of topical therapy. Little is known of the medium- to long-term outcomes of trabeculectomy in West Africa. Purpose To retrospectively assess outcomes, in terms of lowering of the intraocular pressure and preserving the visual acuity, and the safety of trabeculectomy in patients with advanced glaucoma in Nigeria. METHODS: A retrospective case-note search was carried out from operating theatre records in a private hospital at Lagos, Nigeria from 1989 to 1997. Patients undergoing primary trabeculectomy with a minimum follow-up of 6 months were included in the study. Visiting consultants and registrars from the UK performed the surgery. Descriptive statistics and life-table analysis were applied to the data. RESULTS: One hundred and forty-two eyes of 100 patients were included in the study. When the criteria for success were an intraocular pressure (IOP) of less than 22 mmHg, 30% reduction from pre-operative levels and a decrease in visual acuity of less than 3 Snellen chart lines, then by life-table analysis success rates were 85%, 82% and 71% at the 1, 2 and 5 year post-operative intervals respectively. Success rates were lower if an IOP of less than 16 mmHg was taken as one of the criteria (65%, 61% and 46% at the 1, 2 and 5 year intervals, respectively). CONCLUSIONS: Trabeculectomy without antimetabolite use appears to be an effective way to lower the IOP of advanced glaucoma patients in Nigeria to less than 22 mmHg but not to less than 16 mmHg. The procedure, in experienced hands, is relatively safe with few major complications.

Aged↗
PubMed2005

South-East Scotland trabeculectomy survey.

AIM: Assessment of trabeculectomy in South-East Scotland (SESTS) with comparison to National Survey of Trabeculectomy (NST) and outcomes of consultant and trainee surgery. METHOD: A retrospective study of 304 consecutive, primary trabeculectomies, in two Scottish centres (Edinburgh and Dunfermline) with two glaucoma specialists and higher surgical trainees, was performed. The study group had primary open angle glaucoma (65.5%), pseudoexfoliation (6.9%), normal tension glaucoma (7.6%), pigment dispersion syndrome (1.6%), and other complicated glaucoma (18.4%). All patients underwent trabeculectomy by the glaucoma specialist (57.6%) and higher surgical trainee (42.4%) with close scrubbed supervision. RESULTS: Compared to the NST, the waiting time for surgery (<3 months) was significantly less in the SESTS (P<0.001). There was also significantly more use of intraoperative antimetabolites (P<0.01), bleb intervention (P<0.001), and a higher rate of early complications (P<0.025). There was no significant difference in outcome at intraocular pressure (IOP)<2/3 listing IOP (qualified and unqualified) between the SESTS and the NST. Significantly, more patients achieved an unqualified success of IOP<21 mmHg (P<0.01) and an unqualified success of IOP<16 mmHg in the SESTS than the NST (P<0.05). At 1 year post surgery, visual loss of greater than one Snellen line was more common in the NST (P<0.01) as was the use of anti-glaucoma medication (P<0.001). Trainee cases returned to theatre more frequently (P<0.025) and merited more bleb intervention (P<0.01) than consultant cases, but the long-term outcome was similar. CONCLUSION: Our study highlights significant changes in the practice and outcome of trabeculectomy compared to the national survey conducted a decade ago.

Aged↗
PubMed2006

The relation of volume and outcome in trabeculectomy.

BACKGROUND/AIMS: Higher case volume has been associated with improved outcomes for a number of procedures. This study was designed to investigate whether this relationship existed for trabeculectomy. METHODS: The study was retrospective and conducted at an ophthalmic unit in the UK. All patients who had unenhanced trabeculectomy between 1996 and 2000 were identified. From their notes, the surgeon who performed the trabeculectomy was ascertained as were any unplanned interventions (eg conjunctival suturing, anterior chamber reformation, repeated attendances) within the first month of surgery. RESULTS: Two hundred and eleven trabeculectomies were performed over the study period. Twenty nine had unplanned interventions within the first postoperative month. Analysis of the data indicated that surgeons who performed less than eight operations per year had more complications than those who performed more than 10 per annum. This difference was only significant (chi(2)=4.0, P=0.045) when the data were aggregated. When separated per year, although not significant, the complication rate of the lower volume group was always higher than the group performing more than 10 per year. CONCLUSIONS: The results suggest that trabeculectomy can be added to the list of procedures in which larger case volume is associated with fewer early complications and potentially a better outcome. The findings, if replicated, tend to strengthen the argument for subspecialisation in glaucoma with its implications for training and revalidation.

Adult↗
PubMed2001

Indocyanine green anterior segment angiography for studying conjunctival vascular changes after trabeculectomy.

BACKGROUND: The aim of the study was to evaluate the use of indocyanine green (ICG) for angiography of the anterior segment to characterize conjunctival and episcleral vasculature changes after trabeculectomy. METHODS: This was a prospective evaluation of anterior segment ICG angiography in 10 eyes of 10 patients undergoing trabeculectomy for the first time. Trabeculectomy was performed with intraoperative sponge application of 5-fluorouracil (5 cases) or mitomycin C (5 cases). Anterior segment ICG angiography was performed prior to surgery, then at 2 weeks and 2 months after surgery. RESULTS: With ICG, the anterior segment vessels were well delineated, including deep episcleral veins, which have not been clearly shown in previous angiographic techniques. Late phases of the angiogram could also be studied. The vascular alterations after trabeculectomy noted included oss of vascularity over the bleb area and vascular anastomoses along the perimeter of the avascular bleb. CONCLUSIONS: Angiography using ICG has potential as an investigative tool to study the conjunctival and episcleral vasculature changes after trabeculectomy.

Adult↗
PubMed2004

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population.

PURPOSE: A retrospective cohort study was undertaken to evaluate and compare the long-term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. METHODS: Yearly diurnal measurements of intraocular pressure (IOP), best-corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti-mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. RESULTS: Sixty-four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to < or = 21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two-line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. CONCLUSIONS: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.

Aged↗
PubMed2000

[Long-term follow-up of 700 trabeculectomies].

BACKGROUND: A major focus of our study was to determine the value of postoperative intraocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). PATIENTS AND METHODS: The medical charts of 547 patients undergoing glaucoma filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The eyes with congenital glaucoma and those treated with anti-metabolites were excluded. RESULTS: Defining the qualified criteria for success of trabeculectomy as an IOP </21 mm Hg throughout the entire study period, no evidence of progressive disc damage or further visual field loss, no decrease in visual acuity and no additionally required surgical intervention due to glaucoma, there was a success rate of 44.4%. In 50% the tonometric failure took place within the first 34 days trabeculectomy. No significant difference in survival by sex (p = 0.53), surgical technique, limbal versus fornix-based flap (p = 0.28) and by type of glaucoma (p = 0.26) was shown. But the patient group with prior argon laser trabeculoplasty had a significant lower success rate in terms of normalization of IOP (p = 0.03). There was no significant difference in the outcome of trabeculectomy between the first and second eye. CONCLUSION: The identification of patients at risk of failure in terms of IOP in the early post-operative period is possible, thus, closer follow-up and early medical or surgical intervention may be indicated. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma and in case of failure in the first eye, this would allow options, such as the use of anti-metabolites in the second eye.

Adult↗
PubMed1997

Subconjunctival retention of C3F8 gas increased the success rates of trabeculectomy in young people.

In this study, the effect of subconjunctival retention of perfluoropropane (C3F8) gas on trabeculectomy was evaluated to determine if this maneuver would increase the success rate of the surgery. Thirty-two patients (under 35 years old) with a diagnosis of primary open-angle glaucoma or steroid-induced glaucoma were randomized into two groups to receive trabeculectomy: Group A (trabeculectomy alone, 16 eyes) and Group B (trabeculectomy with subconjunctival retention of 0.5 mL pure C3F8 gas, 16 eyes). The results showed that the typical appearance of a subconjunctivally retained C3F8 filtering bleb is highly distended in the first two weeks after surgery, followed by flattening and diffusing gradually. The average retention time of C3F8 gas within the subconjunctival space is 28 +/- 6 days. A higher success rate was noted in Group B than in Group A (94% versus 50%, p = 0.016) at a mean follow-up time of 12 months. However, there were no differences in complication rates and results of final visual acuity between the two groups (both groups had two patients lose more than two lines of vision, p = 1.0). Our study suggests that subconjunctival retention of C3F8 gas increases the success rate of trabeculectomy in young people in the intermediate-term (12 months) follow-up period.

Adult↗
PubMed2000

The application of water drinking test on the evaluation of trabeculectomy patency.

The water drinking test (WDT) was once frequently used as a diagnostic tool for glaucoma, but not so often nowadays. In this study, we investigated the potential use of the WDT on the evaluation of trabeculectomy patency. Twenty age-matched volunteers and thirty-six glaucoma patients who were to receive trabeculectomy procedure were enrolled in this study. The WDT was given to the volunteers once and to all glaucoma patients before undergoing trabeculectomy and at certain intervals after the procedure. The WDT was performed in a standard manner. We defined four parameters after performing the WDT: Initial Pressure [IP, intraocular pressure (IOP) level before the WDT]; Slope of Ascending Trend (SOAT, the slope between baseline IOP and the highest IOP level); Peak Pressure (PP, the highest IOP level during the WDT); and End Pressure (EP, the IOP level after the WDT). It was found that the results of the WDT and trabeculectomy patency were strongly correlated. The four parameters in success and failure cases were significantly different at the last follow up: IP: (15.2 +/- 3.6 vs. 25.3 +/- 6.4, p<0.01); SOAT: (0.9 +/- 0.3 vs. 1.8 +/- 1.2, p<0.01); PP: (19.2 +/- 6.4 vs. 39.5 +/- 12.2, p<0.01); EP: (15.5 +/- 4.8 vs. 29.4 +/- 8.2, p<0.01). Thus, it was observed in this study that WDT was not only easy and safe to perform, but also valuable in evaluating the patency of trabeculectomy.

Adult↗
PubMed2002

Corneal endothelial damage after trabeculectomy with mitomycin C in two patients with glaucoma with cornea guttata.

PURPOSE: To report two patients with glaucoma who exhibited severe damage to the corneal endothelium after a trabeculectomy with mitomycin C (MMC). METHODS: This study includes clinical histories and specular microscopic pictures of the cases. RESULTS: Both patients were middle-aged women, underwent trabeculectomy with MMC, had moderate to severe cornea guttata preoperatively, and developed a shallow to flat anterior chamber, classified as grade 2 according to Spaeth early in the postoperative period. Stromal opacity caused by corneal edema associated with severe Descemet's membrane folds appeared within 2 to 5 days in both cases. The density of the corneal endothelium was decreased on specular microscopic examination. The severe corneal endothelial damage seen after the trabeculectomy with MMC was likely owing to a combination of the preexisting cornea guttata, the flat anterior chamber, and possibly the administration of MMC. CONCLUSION: Severe endothelial damage after trabeculectomy with MMC may occur in patients with glaucoma and associated cornea guttata. The use of tight sutures on the scleral flap or a modified operative method, nonpenetrating trabeculectomy, may be effective in preventing a shallow to flat anterior chamber postoperatively.

Adult↗
PubMed1998

Technique and outcome of combined phacoemulsification and trabeculectomy.

The efficacy of combined surgery for the treatment of concurrent glaucoma and cataract has long been under scrutiny. Comparisons between sequential surgery and combined procedures have shown mixed results, and current guidelines have been drawn for the indication of combined surgery. The evolution of combined triple surgery--cataract extraction, intraocular lens implantation, and filtering procedure--has evolved from planned extracapsular cataract extraction to small-incision phacoemulsification. The improvements of phacoemulsification over extracapsular surgery have naturally given rise to improvements in the results of combined procedures; good outcomes in both intraocular pressure control and visual acuity have been reported along with low complication rates. The techniques of combined phacoemulsification-trabeculectomy are under continual development as new sutureless incisions, filtration procedures, and antimetabolite use are studied. The results of numerous studies show that the combined procedure is an effective method of treatment of glaucoma and cataract. This review examines various recent aspects of the combined procedure, phacoemulsification-trabeculectomy, antimetabolites, results and complications, as well as current developments of new techniques. In addition, we review studies on combined cataract extraction and trabeculectomy, including older literature on planned extracapsular extraction plus trabeculectomy as well as newer studies on phacoemulsification-trabeculectomy.

Antimetabolites↗
PubMed2000

Effects of atropine on anterior chamber depth and anterior chamber inflammation after primary trabeculectomy.

PURPOSE: To investigate the effects of postoperative atropine on central and peripheral anterior chamber depth and anterior chamber inflammation in patients undergoing primary trabeculectomy. METHODS: Two separate groups of patients who were phakic without previous intraocular surgery undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine. In the first group of patients, 24 eyes of 21 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber depth was measured. Central and peripheral chamber depths were measured using the EAS-1000 anterior segment analysis system (Nidek, Tokyo, Japan) before surgery and on postoperative days 1, 3, 7, 14, and 30. In the second group, 34 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber reaction was documented. The amount of cells and flare was measured using the Kowa laser flare meter (FM-500) and cell counter (LC-500) (Kowa Electronics and Optics, Tokyo, Japan) preoperatively and on postoperative day 1, 7, and 30. RESULTS: Compared with preoperative measurements, a small (approximately 0.1 mm) but statistically significant deepening of the central and peripheral anterior chamber depth on days 1, 7, 14, and 30 was found in patients who used atropine. In the nonatropine group, no statistically significant change was found in central or peripheral anterior chamber depths at any time as compared with preoperative values. There was no statistically significant difference in the cell or flare counts between the atropine and nonatropine groups at any time. CONCLUSIONS: This study showed a small but statistically significant deepening of the anterior chamber with atropine. No statistically significant differences were observed in the cell or flare counts between atropine and nonatropine groups. Routine atropine use after trabeculectomy may not be necessary to reduce postoperative complications, such as shallowing of the anterior chamber or anterior chamber inflammation. In patients with a shallow anterior chamber, however, atropine would be expected to deepen the chamber.

Adolescent↗
PubMed2002

Trabeculectomy with antiproliferative agents in uveitic glaucoma.

PURPOSE: To evaluate the outcome of trabeculectomy with antiproliferative agents in patients with uveitic glaucoma METHODS: A retrospective chart review of 44 eyes of 44 patients with uveitic glaucoma who underwent trabeculectomy with mitomycin C or 5-fluorouracil. The authors defined complete success as an intraocular pressure of 21 mm Hg or lower without pressure-lowering medications, qualified success as an intraocular pressure of 21 mm Hg or lower with medications, and failure as an intraocular pressure of more than 21 mm Hg with medications, loss of light perception, or the need for reoperation. RESULTS: The cumulative probability of complete or qualified success was 78% at 1 year and 62% at 2 years. At 2 years, success rates were 39% in males and 71% in females (P = 0.02), 74% in white patients and 55% in black patients (P = 0.58), and 45% in patients with idiopathic uveitis and 74% in patients with sarcoid uveitis (P = 0.17). Sixteen of 31 (51.6%) phakic patients developed new cataracts or had progression of existing cataracts and required cataract extraction. Four of 16 eyes (25%) lost intraocular pressure control and needed repeat trabeculectomy after undergoing cataract surgery. CONCLUSIONS: Patients with uveitic glaucoma can have good outcomes after trabeculectomy with antiproliferative agents. Male gender was the only statistically significant risk factor for trabeculectomy failure. Cataract management in the presence of a filtering bleb poses a treatment dilemma between improvement of visual acuity and loss of intraocular pressure control.

Adolescent↗
PubMed2005

Trabeculectomy with internal tube shunt: a novel glaucoma surgery.

PURPOSE: To describe a pilot study that evaluates the efficacy and mechanism of action of a new glaucoma operation, trabeculectomy with internal tube shunt. METHODS: Twenty-three patients underwent the new operation in one eye for open angle glaucoma. Under a scleral flap, a deep sclerectomy was performed, resulting in an intrascleral lake. Laterally, on both sides, a small silicone tube was placed between the intrascleral lake and the suprachoroidal space. A trabeculectomy stoma and a peripheral iridectomy permitted easy access of aqueous to the tube. Postoperative and preoperative results were analyzed and also compared with results of 45 eyes that underwent a conventional trabeculectomy. RESULTS: After a mean follow-up time of 324 days, the mean postoperative IOP was 13.8 mm Hg compared with a preoperative value of 25.4 mm Hg. The mean number of postoperative medications was only 1.1 compared with a preoperative value of 3.0. No significant change in outflow facility was seen. The bleb size was very small. In comparison, in conventional trabeculectomy eyes, the outflow facility and bleb size were significantly larger. CONCLUSION: Trabeculectomy with internal tube shunt is very effective in lowering IOP. It is postulated to work, to a large extent, by allowing access of the aqueous humor to the suprachoroidal space where the protein colloid osmotic pressure of uveal blood causes its absorption. This new procedure offers many advantages over other filter procedures and tube shunts.

Adult↗