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PubMed2006

Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients.

PURPOSE: To determine the long-term intraocular pressure (IOP) control and postoperative complications after initial trabeculectomy with use of mitomycin C (MMC) in patients with primary open-angle glaucoma (POAG). PATIENTS AND METHODS: A retrospective review was conducted of a consecutive series of 123 eyes (87 patients) with POAG who underwent initial trabeculectomy with MMC and had at least 4 years of follow-up. All patients underwent standard trabeculectomy with 0.04% MMC applied intraoperatively for 3 minutes. The long-term outcomes (IOP control and bleb leak, long-standing hypotony, bleb-related infections) were analyzed with the Kaplan-Meier life-table method on the basis of three definitions of successful IOP control (defined as IOP <18 mmHg (definition 1), IOP <16 mmHg (definition 2), and IOP decrease of by > or =30% and <21 mmHg (definition 3)). RESULTS: The mean follow-up time was 6.8+/-1.4 (mean+/-SD) years. The cumulative survival rates were 67.0+/-4.6%, 44.5+/-5.4%, and 74.1+/-4.2%, respectively, based on definitions 1, 2, and 3, 8 years postoperatively by life-table analysis. At 8 years, bleb leak occurred in 7.9+/-2.6% of eyes, long-standing hypotony in 8.3+/-2.5%, and bleb-related infections in 5.9+/-2.4%. CONCLUSION: Long-term outcome after initial trabeculectomy with MMC in Japanese POAG patients is comparable with that reported in other populations and with that after trabeculectomy with 5-fluorouracil.

Adult↗
PubMed2007

Primary trabeculectomy surgery performed by residents at a county hospital.

PURPOSE: To evaluate the safety and efficacy of trabeculectomies performed by ophthalmology residents at a metropolitan county hospital, under the supervision of attending physicians. METHODS: A retrospective analysis of resident-performed trabeculectomies at the San Francisco General Hospital from the period of 1994 to 2004 was performed. The preoperative and postoperative ocular data of 50 eyes in 35 patients were evaluated. Of the 50 cases, 47 procedures were performed as primary trabeculectomies and 3 were revisions of trabeculectomies. RESULTS: The average follow-up period was 28.9+/-17.6 months with an intraocular pressure (IOP) decrease from 23.2+/-9.4 mm Hg preoperatively to 11.3+/-4.4 mm Hg at last follow-up, for a mean reduction of 11.9+/-10.5 mm Hg (51.6%) (P<0.0001). Follow-up periods ranged from 3 months to over 6 years. The number of medications required decreased from 3.2+/-1.1 to 0.6+/-0.1 (P<0.0001). Success, defined by a postoperative IOP < or =21 mm Hg or a decreased postoperative IOP of at least 25% from preoperative pressure if the preoperative IOP was already < or =21 mm Hg, was observed in 42 eyes (84%) at last follow-up. Best-corrected visual acuity was stable or improved in 22 eyes (44%) and was noted to decrease 2 or more Snellen lines in 28 eyes (56%). Notable complications included 3 cases (6%) of persistent hypotony (IOP<5), 1 case (2%) of late endophthalmitis, and 1 case (2%) of phthisis. Seven eyes (14%) required subsequent penetrating glaucoma procedures due to bleb failure. CONCLUSIONS: Results of this study suggest that the outcomes of trabeculectomies performed by residents at a county hospital can have a high success rate, comparable with previous studies in the literature. Rates of complications are overall similar to those found in the published literature.

Adult↗
PubMed2006

Trabeculectomy with brief exposure to mitomycin C.

BACKGROUND: To evaluate the safety and efficacy of primary trabeculectomy with brief exposure (15 s) to mitomycin C (MMC) (0.4 mg/mL). METHODS: Medical record review of all patients who underwent primary trabeculectomy with brief exposure to MMC at the Goldschleger Eye Institute in a 4-year period was performed. RESULTS: Sixty-three patients (35 men, mean age of 55 years) underwent trabeculectomy with brief exposure to MMC. Intraocular pressure (IOP) decreased a mean +/- standard deviation of 17.9 +/- 9.6 mmHg from 30.4 +/- 9.5 mmHg preoperatively to 12.5 +/- 6.2 mmHg postoperatively after a mean follow up of 18.3 months (P < 0.001). Number of antiglaucoma medications decreased from 2.9 +/- 1.1 preoperatively to 0.2 +/- 0.4 postoperatively (P < 0.001, paired samples t-test). Complete success, defined as IOP < 18 mmHg without antiglaucoma medication, was achieved in 46 patients (73%) and qualified success, defined as IOP <or= 21 mmHg with or without antiglaucoma medications, was achieved in 59 patients (93.7%). Thirty-eight patients (60%) had a final IOP < 15 mmHg with no glaucoma medications at the end of follow up. Needle revision was required in four patients (6.3%) and repeated trabeculectomy was performed in three patients (4.8%). Four patients had an IOP of less than 6 mmHg at the end of follow-up period (three had final IOP of 5 mmHg and one of 4 mmHg); these patients had an average larger bleb size (2.8 +/- 1.3). CONCLUSIONS: Trabeculectomy with brief (15 s) exposure to MMC 0.4 mg/mL is safe and effective in lowering IOP in this group of patients, and results in low rate of postoperative complications. Success is comparable to reported data with longer exposure durations to antimetabolites.

Alkylating Agents↗
PubMed1987

Early post-operative pressure rise with ciliary body incarceration into Watson type trabeculectomy fistula.

We studied six patients with early failure after Watson's trabeculectomy done due to chronic simple, neovascular, or chronic angle-closure glaucoma. After operation the eyes showed a maximum intraocular pressure (IOP) between 50 mmHg and 66 mmHg and no filtering bleb. Reoperation on the 5th to 14th post-operative day showed incarceration of ciliary body into the trabeculectomy fistula in all cases. The uveal protrusion was replaced and a deep corneoscleral block was removed in front of the scleral spur in three cases, and electrocoagulation of the anterior edges of the trabeculectomy fistula was done in other three cases. After a 4 months to 1.5 years follow-up IOP was 12 mmHg to 18 mmHg and only two eyes needed medical therapy. The results suggest that trabeculectomy in front of the scleral spur is indicated to avoid incarceration of the ciliary body into the trabeculectomy fistula.

Aged↗
PubMed1988

Early trabeculectomy versus conventional management in primary open angle glaucoma.

The results of a randomised, prospective, multicentre trial of the management of primary open angle glaucoma are presented at up to five years' follow up. Previously undiagnosed cases were selected with intraocular pressure of 26 mmHg or more on two occasions together with field loss characteristic of glaucoma. Analysis was performed on one eye selected at random from each of 99 patients. Conventional medical treatment followed in unsuccessful cases by trabeculectomy (group A) was compared with trabeculectomy at diagnosis followed when necessary by supplementary medical therapy (group B). The life expectancy of these glaucoma patients was found to be similar to that for the local population matched for age and sex. In group A after four years trabeculectomy had been performed in 53% of eyes because medical management had failed to control the disease. The rate of operation was lower in those patients with intraocular pressure less than 31 mmHg and mild relative field loss (17% at three years) than in those with intraocular pressure greater than 30 mmHg and dense scotomas (75% at three years). Early surgery provided much more stable control with fewer changes in treatment than in group A. The group mean intraocular pressure after trabeculectomy was 15.0 mmHg irrespective of the time of operation, and this was significantly lower than the intraocular pressure in those cases thought to be controlled on medical therapy alone at the end of the first year (20.8 mmHg). Early operation provided significantly better protection of visual field, and the extra loss of visual field with delayed operation occurred in the preoperative period. Changes in visual fields were not related to the use of miotics. There was no significant difference in the final visual acuity in the two groups, but six cases in group A lost central fixation because of progressive loss of visual field, and there were no such cases in group B. Cataract occurred in approximately 10% of cases in both groups, but in group A this happened with only half the number of operations and at a shorter postoperative follow-up than in group B. It appears that in cases of primary open angle glaucoma of this severity the risk of delaying operation are significantly greater than those of performing trabeculectomy as the primary treatment.

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PubMed1993

Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy.

In order to determine if post-traumatic angle recession is a risk factor for failure of glaucoma filtering surgery independent of age or race, the surgical results of trabeculectomy performed in 35 consecutive patients with angle recession glaucoma were compared with those of 35 matched patients with primary open angle glaucoma. A postoperative intraocular pressure of < or = 21 mm Hg (with or without glaucoma medication) was found in 15 of the 35 (43%) patients with angle recession glaucoma compared with 26 of the 35 (74%) patients with primary open angle glaucoma. The long term success of trabeculectomy was significantly worse in angle recession glaucoma when the results were analysed using Kaplan-Meier survival curves. Bleb failure occurred a mean period of 3.1 (SD 1.2) months after trabeculectomy in angle recession glaucoma compared with 9.4 (5) months in primary open angle glaucoma (p < or = 0.001). The finding that posttraumatic angle recession is a risk factor for failure of trabeculectomy, supports the use of antimetabolite therapy to suppress fibrosis after trabeculectomy in these patients.

Adult↗
PubMed1999

Risk factors for failures of trabeculectomies performed without antimetabolites.

AIMS: To assess the risk profile for the failure of trabeculectomies in a large group of patients who were selected to be operated on without the use of antimetabolites. This was done in an effort to find subgroups of patients who may not need antimetabolites for primary procedures. METHODS: Consecutive patients scheduled for routine trabeculectomies were operated during a 4 year period and were followed up for at least 6 months postoperatively. Patients were regularly examined in the glaucoma unit and by their local ophthalmologists. Pre- and postoperative data were evaluated and success rates determined. RESULTS: 709 eyes of 566 patients were operated on; 534 eyes of 534 patients (94.4%) were finally evaluated. The mean follow up was 27.9 (SD 13.6) months with a range of 6-62 months. Success rates for complete surgical success ranged from 59% in the best group with pigmentary dispersion syndrome to 0% in the worst group with neovascular glaucoma. Success rates of patients with POAG, pseudoexfoliation, chronic angle closure, pigmentary dispersion syndrome, and dysgenetic glaucoma were similar. Failure rates ranged from 11% in the best group (pseudoexfoliation) to 80% in the worst group (neovascular glaucoma). Failure rates were high in complicated forms of glaucoma such as traumatic (30%), buphthalmus (40%), and uveitic (50%). For repeat trabeculectomies, the failure rate was 49% (20 of 41 eyes). The mean time until failure ranged from 2.7 months (traumatic) to 15.5 months (pigmentary dispersion syndrome) and was 4.9 months for repeat trabeculectomies. CONCLUSION: Trabeculectomy performed in selected groups of patients has a favourable outcome without the use of antimetabolites. It may be possible to avoid antimetabolites in these groups of patients for primary procedures.

Adolescent↗
PubMed2000

Anterior chamber flare after trabeculectomy and after phacoemulsification.

AIMS: To evaluate and compare prospectively the anterior chamber inflammatory response after phacoemulsification cataract surgery and after trabeculectomy with peripheral iridectomy. METHODS: Anterior chamber inflammation was measured using the Kowa FM-500 laser flare meter in 131 patients undergoing trabeculectomy and 148 patients undergoing phacoemulsification cataract extraction with intraocular lens implantation. Flare was measured before surgery and on each postoperative visit up to 12 months. RESULTS: Before surgery there was no significant difference in flare readings between the two groups. Following trabeculectomy flare returned to baseline levels 4 weeks after surgery, while following phacoemulsification cataract extraction it remained significantly higher at week 6 (p<0.006) and month 3 (p<0.05). CONCLUSIONS: Anterior chamber inflammation is more prolonged after cataract surgery than after trabeculectomy. This may have implications for the timing of trabeculectomy in relation to cataract surgery.

Aged↗
PubMedDate not supplied

Trabeculectomy with and without mitomycin-C in a black African population.

PURPOSE: To evaluate the beneficial effects of intraoperative application of mitomycin-C during trabeculectomy in a black African population in Congo-Kinshasa. METHODS: A prospective randomized study in 22 eyes (11 patients) with open-angle glaucoma. All patients underwent trabeculectomy with application of mitomycin-C (0.4 mg/ml for 2.5 min) under the scleral flap in the right eye and trabeculectomy alone in the left eye. Assessment of the clinical outcome included intraocular pressure, visual acuity, visual field and complications. The follow-up was 20 months. Success of the filtering surgery was defined as a final IOP of 21 mmHg or lower without antiglaucoma medications and no further glaucoma surgery necessary. RESULTS: The success rate of trabeculectomy was 81.8% in eyes treated with mitomycin-C compared with 63.6% in eyes not receiving this drug. Rates of intraocular pressure reduction were 57.9% and 42.9% respectively. Complications occured in 36.3% of the eyes managed with mitomycin-C against 9% in the control eyes. CONCLUSIONS: Mitomycin-C, as adjunctive treatment during trabeculectomy in black Africans, offers great benefit in lowering IOP, but with a substantial high risk of complications. These data need to be confirmed by further studies in this population.

Adult↗
PubMed2005

Is post-trabeculectomy hypotony a risk factor for subsequent failure? A case control study.

BACKGROUND: Ocular hypotony results in an increased break down of the blood-aqueous barrier and an increase in inflammatory mediator release. We postulate that this release may lead to an increased risk of trabeculectomy failure through increased bleb scarring. This study was designed to try to address the question if hypotony within one month of trabeculectomy for Primary Open Angle Glaucoma (POAG), is a risk factor for future failure of the filter. METHODS: We performed a retrospective, case notes review, of patients who underwent trabeculectomy for POAG between Jan 1995 and Jan 1996 at our hospital. We identified those with postoperative hypotony within 1 month of surgery. Hypotony was defined as an intraocular pressure (IOP) < 8 mmHg or an IOP of less than 10 mmHg with choroidal detachment or a shallow anterior chamber. We compared the survival times of the surgery in this group with a control group (who did not suffer hypotony as described above), over a 5 year period. Failure of trabeculectomy was defined as IOP > 21 mmHg, or commencement of topical antihypertensives or repeat surgery. RESULTS: 97 cases matched our inclusion criteria, of these 38 (39%) experienced hypotony within 1 month of surgery. We compared the survival times in those patients who developed hypotony with those who did not using the log-rank test. This data provided evidence of a difference (P = 0.0492) with patients in the hypotony group failing more rapidly than the control group. CONCLUSION: Early post-trabeculectomy hypotony (within 1 month) is associated with reduced survival time of blebs.

Case-Control Studies↗
PubMedDate not supplied

Long-term results of trabeculectomy for congenital glaucoma.

BACKGROUND: To evaluate long-term results of intraocular pressure after trabeculectomy for congenital glaucoma. METHODS: Data concerning 55 eyes (30 patients) who underwent trabeculectomy for congenital glaucoma were recorded. Mean age at diagnosis was 3.4 months (range: 2 days to 10 months). Mean follow up was 56.8 months. Associated anterior segment abnormalities, need for one or more new trabeculectomy procedures during follow up, and intraocular pressure at the last examination were noted. RESULTS: Of the 55 eyes, 48 met the success criteria (87.3%). A second and sometimes third or fourth trabeculectomy were necessary during follow up in 17 eyes (31%). Of the seven failures at final examination, six (85%) had been diagnosed and operated on before the age of 1 month, whereas 15 of the 48 eyes with good results (31.2%) were in this group (p < 0.02). Of the seven failures at final examination, six (85%) were operated on two to four times, whereas 10 of the 48 eyes with good results (20.1%) were in this group (p < 0.01). An associated anterior segment abnormality was present in 13 eyes (23%), and did not seem to influence the final outcome. CONCLUSION: Trabeculectomy is an effective procedure for long-term control of intraocular pressure in congenital glaucoma. The early diagnosis and surgical treatment correspond to a poor long-term prognosis, probably related to initially severe cases. In these cases, intraocular pressure is difficult to control despite repeated surgical procedures.

Chi-Square Distribution↗
PubMed1999

Assessment of corneal decompensation in eyes having undergone molteno shunt procedures compared to eyes having undergone trabeculectomy.

PURPOSE: To compare the incidence of corneal decompensation after Molteno shunt to trabeculectomy. METHODS: We conducted a retrospective analysis of the corneal status of 55 patients with primary open angle glaucoma. We compared 24 eyes of 24 patients who underwent Molteno tube shunt placement (Group 1) to fifteen eyes of 14 patients with multiple surgical procedures, including a trabeculectomy (Group 2). We also compared Group 1 to 28 eyes of 17 patients who underwent only one trabeculectomy (Group 3). RESULTS: The three groups were similar with respect to age, sex, and intraocular pressure (IOP). The average follow-up time from the last surgery in Group 1 was 17.9 months (1-90 months), 22.4 months (2-63 months) in Group 2, and 19.6 months (1-37 months) in Group 3. The average number of surgeries was 3.0 (1-4) in Group 1 and 2.53 (1-4) in Group 2. The surgeries included trabeculectomy, cataract extraction, combined procedures, penetrating keratoplasty, pars plana vitrectomy, and scleral buckle. The incidence of corneal edema was 50% (12/24)in Group 1, 6.7% (1/15) in Group 2, and 0% in Group 3 (0/28). The average time to corneal decompensation was 21 months in Group 1 (1-120 months) and 15 months in Group 2. CONCLUSION: Patients undergoing Molteno shunt placement have a higher rate of corneal decompensation compared to patients undergoing trabeculectomy.

Adult↗
PubMed1999

[Use of "low dose" 5-fluorouracil during trabeculectomy].

PURPOSE: This retrospective study was undertaken to evaluate if a "low dose" intraoperative sponge 5-fluorouracil application may improve the quality of the postoperative IOP control without increasing the incidence of postoperative complications following a first trabeculectomy in low-risk and/or severe field defects glaucomatous patients comparatively with a control group. MATERIAL-METHOD: Our study included a total of 41 trabeculectomies performed in 39 patients. An intraoperative sponge 5-FU application (10 mg/ml) was performed during a mean duration of one minute in 28 trabeculectomies. Mean follow-up was 10.1 +/- 5.6 months (range: 3 to 24 months) and was comparable in 5-FU and control group. Mean age of patients (62.9 +/- 11.4 years) was not significantly different in both groups as well as their preoperative mean visual acuity, the severity of their visual field defects, the importance, the nature of preoperative topical medications and the number of sutures in scleral flap during trabeculectomy. The thickness of Tenon capsule was only significantly different in the two groups (p < 0.05). Our success criteria were based on a "target" IOP reached in the last examination with or without adjunctive medical treatment. RESULTS: Mean preoperative IOP was 32.2 +/- 8.4 mm Hg and was reduced in the last control to a mean value of 14.4 +/- 4.0 mm Hg without any significant difference between the 5-FU group and the control group (p > 0.05). The rate of failures was higher in the control group (15.3%) than in the 5-FU group (7.1%) in the last examination. Significantly more eyes (31%) in the control group required adjunctive postoperative medication than in the 5-FU group (3%) in the last follow-up. The incidence and severity of complications were not significantly different in both groups. Postoperative 5-FU injections were performed in a non significant different number of eyes in one group comparatively with the other. Morphologic characteristics of filtration blebs were comparable in the two groups. CONCLUSION: A "low dose" intraoperative 5-FU sponge application during a first trabeculectomy in low-risk patients and/or in patients with severe field defects in whom a low-ten target IOP is mandatory, seems to improve the postoperative IOP control without increasing the incidence of postoperative complications.

Adult↗
PubMedDate not supplied

Photoablative laser-grid trabeculectomy in glaucoma filtering surgery: histology and outflow facility measurements in porcine cadaver eyes.

BACKGROUND AND OBJECTIVE: Mid-infrared laser technology opens new perspectives in experimental glaucoma surgery. The aim of the study was to determine the efficacy of grid-laser trabeculectomy to reduce aqueous outflow resistance sufficiently in perfused porcine cadaver eyes. MATERIALS AND METHODS: Twenty-five freshly enucleated porcine cadaver eyes were randomly assigned to either laser-grid trabeculectomy (LGT), conventional trabeculectomy (CT), or control. In all surgical cases a scleral flap was prepared in a standardized manner. In order to penetrate into the anterior chamber a 1 x 2 mm sclerectomy was performed in CT, and 10 transscleral ablation craters were created in LGT. An erbium:YAG laser (2.96 microm) was used for transscleral photoablation. Radiation was delivered in a single 6 mJ-pulse of 200 micros duration by means of an articulated zirconium fluoride optical fiber and a 200 microm quartz fiber-tip. Outflow facility was measured at a constant perfusion pressure. RESULTS: Laser-grid trabeculectomy (LGT) yielded reproducible ablation areas varying between 210-300 microm in diameter, with 90% being full-thickness penetrations. Collateral thermal damage was less than 30 microm. Outflow facility measurements revealed a statistically significant increase (mean +/- SD) from 0.255 +/- 0.096 microL/min/mm Hg in control eyes (n = 9) to 0.772 +/- 0.157 microL/min/mm Hg in the LGT group (n = 9), and 2.957 +/- 0.602 microL/min/mm in the CT group (n = 7). Flattening of the anterior chamber, folding of Descemet's membrane, and iris prolapse were only observed in the CT eyes but not in the GLT group. CONCLUSION: Application of the laser-grid trabeculectomy produces patent transscleral perforation with minimal collateral tissue damage and effects a significant reduction (67%) in outflow resistance without any postoperative hypotony-related complications.

Animals↗
PubMed2001

Non-penetrating trabeculectomy for open angle glaucoma.

BACKGROUND: Non-penetrating trabeculectomy is used as the surgical intervention for open angle glaucoma. It has advantage of creating gradual filtration through the thin trabeculo-Descemet membrane to reduce markedly the postoperative complications typical for penetrating operation. We described our experience of the non-penetrating trabeculectomy for open angle glaucoma. METHODS: This is a retrospective study of 28 eyes of 28 patients with primary open glaucoma (POAG). Non-penetrating trabeculectomy was performed by one surgeon from July 1998 to March 2000. Examinations were performed preoperatively and postoperatively in 1 and 7 days and 1, 3, 6, 12 and 21 months. RESULTS: The mean follow-up was 12.5 +/- 6.3 months (S.D.). The mean preoperative intraocular pressure (IOP) was 27.8 +/- 6.7 mmHg. The mean postoperative IOP was 11.5 +/- 6.2 mmHg in 1 day and 15.7 +/- 5.8 mmHg in 1 week, and it remained stable in the following 12 months. IOP of 71.3% (20/28) of the eyes could be controlled below or equal to 21 mmHg with no or only topical antiglaucoma medication. There were only few postoperative complications. CONCLUSIONS: Non-penetrating trabeculectomy is efficient in controlling intraocular pressure of open angle glaucoma. No entering the anterior chamber diminishes the postoperative complications typical of the penetrating trabeculectomy.

Aged↗
PubMed2001

[Supraciliochoroidal fluid at an early stage after trabeculectomy].

PURPOSE: To examine the supraciliochoroidal fluid(SCF) by ultrasound biomicroscopy(UBM) at an early stage after trabeculectomy. SUBJECTS AND METHODS: Fifteen eyes without post-operative complications were examined by UBM before the operation and less than 2 weeks after trabeculectomy with mitomycin C. RESULTS: SCF was detected postoperatively in 6 eyes. One eye had choroidal detachment under indirect-ophthalmoscope and 5 eyes(33%) had SCF without choroidal detachment. The SCF in 4 eyes disappeared within 4 weeks after trabeculectomy. The intraocular pressure was 6.4 +/- 3.4 mmHg(mean +/- standard deviation) when SCF was detected and it rose to 13.2 +/- 7.2 mmHg when SCF disappeared. The intraocular pressure was 11.4 +/- 4.0 mmHg in the eyes without SCF, which was significantly higher than in the eyes with SCF. CONCLUSION: At an early stage after trabeculectomy, SCF was detected by UBM in some cases without ophthalmoscopic choroidal detachment. 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 early low intraocular pressure and that disappearance of SCF induces the elevation of intraocular pressure.

Aged↗
PubMedDate not supplied

Patient comfort with combined anterior sub-Tenon's, topical, and intracameral anesthesia versus retrobulbar anesthesia in trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery.

PURPOSE: To assess patient comfort using combined anterior sub-Tenon's, topical, and intracameral ("Blitz") anesthesia versus retrobulbar anesthesia in glaucoma surgery. PATIENTS AND METHODS: In this study, 139 consecutive patients who received retrobulbar anesthesia and 139 consecutive patients who received Blitz anesthesia during glaucoma surgery were evaluated in a prospective fashion. The retrobulbar group included 49 trabeculectomies, 36 aqueous shunts, and 54 phacotrabeculectomies. The Blitz group included 49 trabeculectomies, 30 aqueous shunts, and 60 phacotrabeculectomies. Patients were asked to assess their level of ocular pain operatively and postoperatively on a 10-point visual analog scale. The operative and postoperative pain scores and postoperative sedation of patients receiving retrobulbar anesthesia were compared with those of patients receiving Blitz anesthesia during trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery, separately. RESULTS: No statistically significant difference was found in the mean operative or postoperative pain scores between the two groups during trabeculectomy, phacotrabeculectomy, or aqueous shunt surgery. CONCLUSIONS: Blitz anesthesia offers a reasonable alternative to retrobulbar anesthesia for trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery.

Aged↗
PubMed2003

Histopathologic features of trabeculectomy surgery.

PURPOSE: Trabeculectomy surgery is the most common operative procedure for the treatment of medically uncontrolled glaucoma. Variability exists in both the design and the position of the limbal wound as well as in outcomes, even in cases with similarly designed wounds. The purpose of this study is to describe the histologic features of the surgical site of human eyes received at a pathology laboratory that had undergone trabeculectomy surgery and then attempt to explore possible associations of these features with success or failure of surgery. METHODS: We examined 64 autopsy and enucleated eyes of 53 patients obtained at the Eye Pathology Laboratory, Wilmer Eye Institute, Baltimore, Md, between January 16, 1974, and November 15, 1999. Examined aspects included the position, dimensions, and depths of the trabeculectomy site; features at the internal opening; and the inclusion of trabecular meshwork in the internal resection. An attempt was also made to judge the success of the trabeculectomy by a comparison of preoperative and postoperative intraocular pressures. RESULTS: Of all the histopathologic features examined, there was a statistical difference between the success and failure groups in only the presence of a cleft and the location of the posterior incision. CONCLUSIONS: The main finding of this study is that there is a large degree of variability in the size, position, and pathologic features of trabeculectomy sites. Features that can be avoided with the initial surgical approach, particularly a posterior resection posterior to the scleral spur, may increase the chance of surgical failure.

Aged↗