Abstract
To elucidate the role of trabeculectomy in advanced glaucoma. Only patients with primary open-angle glaucoma were selected. All patients who had cup-disc ratio of 0.9 or a near-total cupping were given a trial of aggressive maximum medical therapy for IOP control for at least 4weeks. Target IOP was defined as≤12mmHg. Patients who showed progression were included in the study. A total of 10 patients were selected. Trabeculectomy was performed using limbal-based conjunctival flap. Patients were followed up for a period of 2years for visual acuity, intraocular pressure, visual fields, slit-lamp biomicroscopy and bleb morphology. Mean preoperative intraocular pressure on five drugs was 21.7±3.8mmHg (range 18-27mmHg) on maximum medical therapy. Mean post-operative intraocular pressure was 11±1.78mmHg (range 9-13mmHg) and 11±1.92mmHg (range 9-14mmHg) at 1 month and 6months post-operatively, respectively. Post-operatively, the visual acuity remained stable in 17 patients. It dropped by 1 Snellen line in 2 patients and 2 Snellen lines in 1 patient, respectively, over a period of 6months and later improved to 6/6P following cataract surgery. There was no defined visual field progression in any of the 20 patients. Besides being a cost-effective alternative to medical management, trabeculectomy not only provides a better IOP control but also has a high safety profile when performed by an experienced surgeon.
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