Modified trabeculectomy in primary acute angle-closure with high intraocular pressure and extremely dilated pupil

Abstract

Objective To determined the outcome of modified trabeculecotomy (with paracentesis,mitomycin C, scleral flap adjustable suture and formation of anterior chamber at the end of the surgery) in the management of primary acute angle-closure (PAAC) with high intraocular pressure (IOP) and extremely dilated pupil. Methods Twenty-one eyes of 21 successive cases with PAAC with high lOP (IOP ＞ 30mmHg) and large pupil (maximum vertical diameter ＞ 5 mm) were evaluated prospectively. They underwent modified trabeculecotomy between January 2005 and March 2009. The operative success was defined as IOP ≤ 20 mmHg (± medical therapy) without the necessity of further surgery for glaucoma. Results Success was achieved in all of the eyes (100％) at the postoperative first week. The mean preoperative IOP was (48.25 ± 3.14) mmHg under a mean number of 3.35 antiglaucomotous medications, but it reduced to (10.47 ± 1.15,P ＜ 0.01) mmHg without medication at the first week, (13.86 ± 0.93,P ＜ 0.01) mmHg at postoperative 3rd month respectively. Only 1 eye needed 1 kind of antiglaucomotous eye drop from the 2nd month postoperatively. The mean vertical diameter of pupils was (5.81±0.23) mm preoperatively, (5.92 ±0.21 ) mm at the first week(P ＞ 0.05). No case received section iridectomy. No serious complication was observed.Conclusions Modified trabeculectomy provides reduction of IOP and protection of pupil in cases with PAAC with high IOP and large pupil, and the procedures such as releasing aqueous humor gradually,appliance of scleral flap adjustable sutures and formation of anterior chamber at the end of the surgery can effectively reduce the risk of serious complications. Key words: Acute angle-closure; ; High intraocular pressure ; Dilated pupil; Trabeculectomy; Microsurgical operation