Success Rate Of Trabeculectomy Research Articles

KEBERHASILAN OPERASI TRABEKULEKTOMI PADA GLAUKOMA SUDUT TERBUKA PRIMER PERIODE 2019-2021

Introduction: Glaucoma represents a group of diseases defined by a characteristic optic neuropathy that is consistent with remodeling of the connective tissue elements of the optic nerve head and with loss of neural tissue associated with the eventual development of distinctive patterns of visual dysfunction. The most common surgery for glaucoma treatment is trabeculectomy, which in principle is done by creating a new channel that drains the aqueous humor, and return the intraocular pressure to normal levels. Objective: This study aimed to know the success rate of trabeculectomy in primary open-angle glaucoma. Methods: This study used a retrospective descriptive research method and was conducted in the Medical Records Center of the Cicendo National Eye Hospital, Bandung City with a data collection period of 21 July 2022 – 6 September 2022. The data collection process was carried out by looking at secondary data from medical records of patients with primary open-angle glaucoma for the period January 2019 – December 2021. Results: Mean IOP decreased from 32.6±12.9 before surgery, to 19.8±10 one week after surgery, and 18.8±7.3 one month after surgery. The overall success rate reaches 82.1%. Conclusions: The success rate for open-angle glaucoma treated with trabeculectomy at Cicendo National Eye hospital is considered good with a total success rate of 82.1% with or without anti-glaucoma medication to control IOP after surgery.

KEBERHASILAN OPERASI TRABEKULEKTOMI PADA GLAUKOMA SUDUT TERBUKA PRIMER PERIODE 2019-2021

Introduction: Glaucoma represents a group of diseases defined by a characteristic optic neuropathy that is consistent with remodeling of the connective tissue elements of the optic nerve head and with loss of neural tissue associated with the eventual development of distinctive patterns of visual dysfunction. The most common surgery for glaucoma treatment is trabeculectomy, which in principle is done by creating a new channel that drains the aqueous humor, and return the intraocular pressure to normal levels. Objective: This study aimed to know the success rate of trabeculectomy in primary open-angle glaucoma. Methods: This study used a retrospective descriptive research method and was conducted in the Medical Records Center of the Cicendo National Eye Hospital, Bandung City with a data collection period of 21 July 2022 – 6 September 2022. The data collection process was carried out by looking at secondary data from medical records of patients with primary open-angle glaucoma for the period January 2019 – December 2021. Results: Mean IOP decreased from 32.6±12.9 before surgery, to 19.8±10 one week after surgery, and 18.8±7.3 one month after surgery. The overall success rate reaches 82.1%. Conclusions: The success rate for open-angle glaucoma treated with trabeculectomy at Cicendo National Eye hospital is considered good with a total success rate of 82.1% with or without anti-glaucoma medication to control IOP after surgery.

The Outcomes of Trabeculectomy Surgery among Patients at Makkah Specialist Eye Hospital Bauchi Nigeria

Trabeculectomy remains the world’s gold standard and the main therapeutic intervention for controlling moderate to advanced glaucoma in Nigeria due to the expensive anti-glaucoma drugs as well as the unavailability of facilities to carry out minimal invasive glaucoma surgery (MIGS). There is still limited knowledge of the outcome of trabeculectomy surgery in northeastern, Nigeria. To determine the outcomes of trabeculectomy surgery regarding lowering post-operative Intra Ocular Pressure (IOP), preserved visual acuity (VA) as well as a preserved functional vision among glaucoma patients attending Makkah Specialist Eye Hospital Bauchi (MSEHB). A retrospective trabeculectomy surgery data search of operating theatre records was done to collect the outcomes from January 2021 to January 2023. Patients who have undergone trabeculectomy with a minimum follow-up of 6 months were included in the study. The criteria for a good outcome were post-operative IOP of less than 22mmHG or at least 30% reduction from pre-operative levels, and a preserved aided VA. A visiting consultant from the Ophthalmology Department of Federal Teaching Hospital Gombe performed the trabeculectomy surgeries. A total of fifty-two eyes of 50 patients having a postoperative follow-up of six months were included in the study. The mean age at presentation was 54.10(± 13.02) years. On the last day before surgery, the mean Snellen VA was 0.37(± 0.36) but became 0.40(± 0.36) post-operatively, p = 0.01, mean cup-to-disc ratio (CDR) was 0.86(± 0.12) but changed to 0.87(± 0.12) p = 0.79 at six months after surgery. Complete success, qualified success (with postoperative anti-glaucoma eyedrops), and failure of trabeculectomy (even with postoperative anti-glaucoma eyedrops) were 47(90.40%), 4(7.70%), and 1(1.90%), respectively. Based on the IOP, the complete success rate of trabeculectomy was 90.40%. The mean preoperative Snellen VA was improved by about half a line, six months after surgery and there was a significant reduction of IOP from its baseline. These outcomes will revolutionize our approach to the referral of suitable candidates for this surgical procedure as well as assure post-operative reserved vision.

Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China: a 325 eyes analysis.

To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (P<0.0001) and 3.0±0.9 to 0.9±1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.

Iris abnormalities may influence the efficacy and filtration strategies of Posner-Schlossman syndrome: a retrospective study involving trabeculectomy, ExPRESS and Ahmed valve implants.

To evaluate and compare the one-year efficacy and influencing factors of different filtration surgeries on Posner-Schlossman syndrome (PSS) patients. A retrospective study enrolling 91 PSS patients who underwent filtering surgeries and were followed for at least one year. Unilateral PSS was diagnosed as recurrent attacks of mild, unilateral, non-granulomatous anterior uveitis, elevated intraocular pressure (IOP), keratic precipitates (KPs) on the corneal endothelium, open angle, no posterior synechia, and no inflammatory lesions in the posterior segment; the IOP and anterior segment returned to normal between attacks. Medical histories and thorough ocular examination results were collected. Trabeculectomy and ExPRESS were chosen as the first line and AGV was considered for those under high risk of fibrosis. Follow-up data, mainly IOP, best-corrected visual acuity (BCVA), and anterior segment manifestations at the 1st week, 6th month, and 12th month were generated and analyzed. Iris abnormalities were determined by depigmentation or atrophic changes on the anterior segment photograph. Complete surgical success was defined as 5 mmHg < IOP ≤ 21 mmHg without IOP-lowering drug or needle revision; qualified surgical success was defined as 5 mmHg < IOP ≤ 21 mmHg with IOP-lowering drugs or needle revisions. Survival analysis was performed to obtain the success rates. At the 12th month, the complete surgical success rate of trabeculectomy (N = 54), ExPRESS (N = 23), and AGV group (N = 14) was 58.97% (95%CI 46.91-77.09%), 84.21% (95%CI 68.33-100.87%), and 100%; the qualified success rate was 71.79% (95%CI 62.46-88.34%), 89.47% (95%CI 77.07-103.33%), and 100%, respectively. Patients undergoing trabeculectomy experienced the largest decline of BCVA (from 0.58±0.46 to 1.01±0.51, P < .05); the trabeculectomy group endured the highest IOP (20.84±9.92 mmHg) compared to ExPRESS (14.51±2.86 mmHg, P < .05) and AGV group (13.17±3.32 mmHg, P < .05). At the 12th month, in the ExPRESS group, patients with iris abnormalities had higher IOP than the normal ones (15.65±2.05 mmHg, 12.93±3.17 mmHg, P < .05). ExPRESS helped patients with iris abnormalities maintain lower IOP than trabeculectomy (15.65±2.05 mmHg, 22.52±10.67 mmHg, P < .05). Three patients developed hypotony at the 3rd month (1 in ExPRESS and 2 in trabeculectomy group). AGV and ExPRESS performed better than trabeculectomy in PSS patients in terms of IOP and success rate. Iris abnormalities might influence the postoperative IOP and this may be valuable in guiding filtration strategies. Chinese Clinical Trial Registry (No. ChiCTR1800017532, date: 2018/08/02).

Early Postoperative Effect of Ripasudil Hydrochloride After Trabeculectomy on Secondary Glaucoma: A Randomized Controlled Trial

Purpose: To evaluate the effect of Rho-associated kinase inhibitor (ripasudil hydrochloride hydrate; ripasudil) eye drops on postoperative intraocular pressure (IOP) after trabeculectomy in eyes with uveitic glaucoma. Design: This was a prospective, observational, controlled, and randomized study. Methods: Sixteen eyes of 16 patients with uveitic glaucoma who underwent trabeculectomy without mitomycin C were randomly treated without ripasudil (8 eyes) and with ripasudil (8 eyes). Postoperative IOP and surgical outcomes 3 months after surgery were compared between the two groups. Results: No patient discontinued treatment due to the lack of efficacy or adverse effects of ripasudil during the 3-month study period in the ripasudil group. The mean IOP (mmHg) in the control and ripasudil groups were 42.5 ± 9.8 mmHg /43.9 ± 11.7 mmHg (p = 0.82) at baseline, 14.3 ± 4.9 mmHg /9.0 ± 3.7 mmHg (p = 0.04) at 1 week, 16.3 ± 4.2 mmHg /10.6 ± 3.0 mmHg (p = 0.01) at 1 month, and 16.0 ± 3.4 mmHg /12.5 ± 2.3 mmHg (p = 0.04) at 3 months. The number of laser suture lysis procedures (2.0 ± 0.5 vs 0.4 ± 0.7), the rate of bleb revision by needling (50.0% vs 0.0%), and the mean number of antiglaucoma medications (1.6 ± 1.5 vs. 0.1 ± 0.3) after trabeculectomy were higher in the control group than in the ripasudil group (all p &lt; 0.05). A multivariate analysis showed that the IOP reduction rate at 3 months after surgery was associated with the use of ripasudil and baseline IOP (all p &lt; 0.05). Conclusion: This study demonstrated the therapeutic efficacy, safety, and tolerability of ripasudil for 3 months postoperatively. Ripasudil may effectively reduce postoperative IOP and increase the success rate of trabeculectomy in patients with uveitic glaucoma.

Is it time for a moratorium on the use of benzalkonium chloride in eyedrops?

Is it time for a moratorium on the use of benzalkonium chloride in eyedrops?

Success Rate of Trabeculectomy in Secondary Glaucoma after Vitrectomy in Kariadi Hospital, Semarang, Central Java

Objectives: Vitrectomy with intravitreal injections of gas or silicone oil is commonly used to treat vitreoretinal diseases such as rhegmatogenous retinal detachment, tractional retinal detachment, and vitreous hemorrhage. Some of these procedure can lead to short-term elevations in intraocular pressure (IOP) and ultimately long-term glaucomatous damage if not treated in a timely manner. Trabeculectomy is a widely performed filtering surgery used in these cases. This study is aimed to define the success rate of trabeculectomy for surgical treatment of secondary glaucoma after vitrectomy in Kariadi Hospital, Semarang, Central Java. Methods: Retrospective study was conducted in secondary glaucoma after vitrectomy patient who underwent trabeculectomy from November 2014-Januari 2019 in Kariadi Hospital. The secondary data of baseline IOP, 1 week, 2 weeks, 1 month, and 3 months after trabeculectomy is obtained from medical records. Results: 19 eyes from 19 patients had mean preoperative IOP 35,56 ± 8,40 mmHg, 1 week 21,01 ± 13,83 mmHg, 2 weeks 26,09 ± 11,27 mmHg, 1 month 29,97 ± 13,45 mmHg, and 3 months 25,47 ± 13,43 mmHg. There was significant differences of IOP level in 1 week, 2 weeks, 3 months (p&lt;0.05), and not significant in 1 month (p 0,171). Complete success rate of trabeculectomy in 1 month was 10,5% and 3 months 10,5%. Qualified success rate in 1 month was 15,8% and 3 months 42,1%. Failed in 1 month was 73,7% and 3 month 47,4%. Conclusions: Trabeculectomy in secondary glaucoma after vitrectomy has low success rate.

Trabeculectomy with OloGen versus Mitomycin C for the Treatment of Silicone Oil-Induced Glaucoma.

To compare the intraocular pressure-lowering effect and success rate of trabeculectomy with OloGen to that of trabeculectomy with mitomycin C (MMC) in cases of silicone oil-induced glaucoma. Forty eyes of forty patients with elevated intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were assigned to two groups. Group A included 20 cases who underwent trabeculectomy with OloGen, while group B cases contained 20 cases undergoing trabeculectomy with MMC. The follow-up period was 24 months. Patients enrolled had IOP > 21 mmHg despite being on antiglaucoma medications. The mean postoperative IOP reduction was lower in group A than in group B at all follow-up visits, but this difference was not statistically significant (p > 0.05). Moreover, group A and B patients were found to be similar as regards the need for postoperative antiglaucoma medications on all follow-up visits. The Kaplan-Meier survival analysis curves for the two groups revealed slightly higher success rates in group B than in group A. However, these differences were not statistically significant for both qualified success (IOP ≤ 21 mmHg with or without antiglaucoma medications) and complete success (IOP ≤ 21 mmHg without antiglaucoma medications). There was no significant difference in the postoperative complication rate between the two groups. OloGen implant lowers IOP to a similar extent as MMC when combined with trabeculectomy for the treatment of silicone oil-induced glaucoma, and with comparable success rates. The rate of postoperative complications is similar for OloGen implantation and MMC.

Trabeculectomy with Ologen implant versus trabeculectomy with P 50 Ex-PRESS shunt in primary open-angle glaucoma

BackgroundThis is the first randomized controlled trial of trabeculectomy with Ex-Press Shunt versus Ologen implant in primary open-angle glaucoma (POAG) in Indian eyes. MethodsA prospective randomized controlled trial of patients of POAG treated with two different methods of augmented trabeculectomy. Group A with Ex-PRESS shunt (P50 model) and Group B with Ologen implant. Surgical success was defined as intraocular pressure of 21 mm Hg or lower at 6 months postoperative. ResultsN = 40 eyes of 33 patients. Baseline IOP in Group A was 23.70 ± 4.6 mm Hg (Range 22–36 mm Hg), and Group B was 26.00 ± 4.0 mm Hg (Range 23–36 mm Hg). Surgical success was achieved in 85% of patients in both Groups. Change in IOP from baseline was statistically significant in both groups at 1, 4, 8, 12 weeks, and 6 months postoperative. No statistically significant difference in the change in IOP between the two groups. Postoperative complications were lesser in Group A compared to Group B, in both early (35% vs 50%) and late stage (20% vs 30%). The drop in visual acuity became statistically insignificant at 4 weeks in Group A and 8 weeks in Group B. ConclusionsThere is no difference between the surgical success rates of trabeculectomy with Ex-PRESS Shunt versus Ologen. However, the Ex-PRESS shunt fares better with lower complication rates and faster visual recovery than the Ologen group.

Different patterns of glaucoma management in South Punjab.

Objectives: Glaucoma is the most common blinding condition in South Punjab of Pakistan and its management is a challenge due to illiteracy and lack of financial resources. Study Design: Randomized Clinical Trial. Setting: Department of Ophthalmology Nishtar Hospital Multan. Period: June 2016 - June 2018. Material &amp; Methods: We have randomly selected patients on the basis of Cup to Disc ratio and applied randomized clinical trial of both medical and surgical modalities of glaucoma management to observe the visual outcomes in terms of Intraocular pressure and Cup to disc ratio. We have also linked the effects of our management with lenticular status of the patients which has shown significant results. Results: The vision survival of trabeculectomy in pseudophakics was 88.77% while only 9.8% was the survival rate of trabeculectomy in phakics. 90% of 31 phakic patients who underwent trabeculectomy failed. Similarly patients on 3 IOP lowering drugs had 70% vision survival rate out of 260 patients treated. Patients with C-D ratio 0.8 had maximum failure rate of 69% out of 78 patients in which medical treatment failed. Conclusion: Trabeculectomy significantly reduced the intraocular pressure in patients in which pharmacological treatment failed.The success rate of trabeculectomy among pseudophakics is high. In Phakics, when only Trabeculectomy is done, success rate is low. When trabeculectomy and clear lens extraction is done simultaneously, the success rate is slightly higher. When trabeculectomy is done after clear lens extraction, the success rate is highest. In case of Cataract, cataract extraction and trabeculectomy when done simultaneously, show low success rate. When trabeculectomy was done after cataract extraction, shows highest success rate.

Inhibition of post-trabeculectomy fibrosis via topically instilled antisense oligonucleotide complexes co-loaded with fluorouracil

Trabeculectomy is the mainstay of surgical glaucoma treatment, while the success rate was unsatisfying due to postoperative scarring of the filtering blebs. Clinical countermeasures for scar prevention are intraoperative intervention or repeated subconjunctival injections. Herein, we designed a co-delivery system capable of transporting fluorouracil and anti-TGF-β2 oligonucleotide to synergistically inhibit fibroblast proliferation via topical instillation. This co-delivery system was built based on a cationic dendrimer core (PAMAM), which encapsulated fluorouracil within hydrophobic cavity and condensed oligonucleotide with surface amino groups, and was further modified with hyaluronic acid and cell-penetrating peptide penetratin. The co-delivery system was self-assembled into nanoscale complexes with increased cellular uptake and enabled efficient inhibition on proliferation of fibroblast cells. In vivo studies on rabbit trabeculectomy models further confirmed the anti-fibrosis efficiency of the complexes, which prolonged survival time of filtering blebs and maintained their height and extent during wound healing process, exhibiting an equivalent effect on scar prevention compared to intraoperative infiltration with fluorouracil. Qualitative observation by immunohistochemistry staining and quantitative analysis by Western blotting both suggested that TGF-β2 expression was inhibited by the co-delivery complexes. Our study provided a potential approach promising to guarantee success rate of trabeculectomy and prolong survival time of filtering blebs.

Subconjunctival Bevacizumab versus Mitomycin C Adjunctive to Subscleral Trabeculectomy

Background: trabeculectomy was considered gold standard procedure for glaucoma treatment. Mitomycin C (MMC) and bevacizumab (BVZ) has been used to increase trabeculectomy success rates. Objective: to compare the outcome of subscleral trabeculectomy with subconjunctival injection of BVZ with that of trabeculectomy with MMC. Patients and Methods: a prospective, non-randomized, comparative study design was used. Thirty eyes from thirty patients with uncontrolled glaucoma were enrolled. Fifteen eyes underwent subscleral trabeculectomy with intraoperative use of MMC (0.2mg/ml for 3 minutes) (group I) and 15 eyes underwent subscleral trabeculectomy with subconjunctival bevacizumab injection (1.25mg/0.1ml) (group II). The outcome measures were the best-corrected visual acuity, intraocular pressure (IOP), number of IOP-lowering medications, complications, and bleb morphologic features (based on the Indiana Bleb Appearance Grading Scale). Results: thirty eyes of thirty patients fulfilled inclusion criteria and assigned to one of two study groups. Each study group included fifteen eyes of fifteen patients. Participants were 14 males and 16 females. Mean ages of patients assigned to MMC and BVZ were 54.0±7.33 and5.7±6.9 years respectively. The difference in mean age was statistically insignificant among treatment groups (p=0.740). Mean number of pre-operative anti-glaucoma medications used by MMC and BVZ treatment groups were 2.47±0.52 and 2.47±0.52 with no significant difference among treatment groups (p=1.00). Conclusions: adjunctive subconjunctival bevacizumab with trabeculectomy is effective in controlling the IOP profile and the post-operative IOP reduction showed no statistically significant different in both group at all postoperative visits. Comparable success rates were achieved in the two groups.

Trabeculectomy with releasable sutures in primary glaucoma: A comparative study with the conventional technique

Aim: To compare the short term and long term efficacy of using releasable sutures versus the conventional permanent sutures for scleral flap suturing in trabeculectomy in terms of incidence of short term hypotony and its related complications, short term shallowing of anterior chamber, long term IOP control after operations by both techniques and post-operative bleb scores. Materials and Methods: This is a prospective study carried out to compare the safety, efficacy and long term success rate of trabeculectomy with releasable suture verses trabeculectomy with permanent sutures. 60 eyes of primary uncontrolled glaucoma were subjected to trabeculectomy surgery, 30 using permanent sutures and 30 using releasable sutures. Patient were randomly assigned into 2 groups for conventional trabeculectomy with interrupted suture (group 1) and trabeculectomy with releasable suture (group 2). Patients were assessed postoperatively on visual acuity, intraocular pressure, anterior chamber depth, immediate complications, anterior chamber depth, post-operative lens changes. Results: Majority patients were male. Age occurrence of open angle glaucoma was between 51-60 years while angle closure glaucoma was between 40 to 50 years. None of the eyes had severe hyotony (IOP less than 6 mmHg in trabeculectomy with releasable suture, while hypotony was a major complication in trabeculectomy with permanent sutures group. Post-operative mean IOP from the end of 3 months till 12 months was found to be equivalent in both groups. In group 1, 5 eyes (16.66%) anterior chamber was well formed compared to 21 eye in group 2. Bleb scores in both the groups suggested, none of the patients in Group 1 had high bleb score between 2-5 days while 13 patients (43.33%) in group 2 had high bleb score. Visual field loss progressed in 5 eyes, 16.66% in group 1. While none of patients had progressive field loss in group 2. Gross hypotony in immediate post-operative period was observed in group 1 while none

Surgical management of glaucoma in Fuchs uveitis syndrome: Trabeculectomy or Ahmed glaucoma valve

PurposeTo evaluate the outcome of trabeculectomy versus Ahmed glaucoma valve (AGV) surgery in patients with Fuchs uveitis Syndrome (FUS). MethodsTwenty-eight eyes with uncontrolled glaucoma and at least 6 months of follow-up were enrolled. In 16 eyes trabeculectomy and in 12 eyes AGV implant were performed. The primary outcome measure was surgical success defined as 5 < intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and 5 < IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than preoperative medications (qualified success). The sum of complete and qualified success was defined as cumulative success. ResultsThe mean age of the patients in the trabeculectomy group and the AGV group was 44.92 ± 9.02 and 45.76 ± 7.10 years, respectively (P = 0.79). The mean duration of follow-up was 23.06 ± 12.03 months in the trabeculectomy group and 22.83 ± 13.63 months in the AGV group (P = 0.96). The baseline mean IOP in trabeculectomy was 26.81 ± 6.69 mmHg which decreased to 11.61 ± 4.15 mmHg at last visit (P < 0.001). In the AGV group, mean IOP was 31.41 ± 6.76 at baseline that changed to 22.41 ± 5.09 at last visit (P = 0.005). According to criterion A, cumulative success rates were 100% and 91% at 6 months and 76% and 9% at 36 months in the trabeculectomy and the AGV group, respectively. Cumulative success rates at 6 months were 93% and 58% and 65% and 7% at 36 months according to criterion B in the trabeculectomy and the AGV group, respectively.Kaplan-Meier survival analysis revealed a significant association between surgical method and cumulative success rate over 36 months (based on criteria A: P = 0.02, and based on criteria B: P = 0.007). ConclusionThe success rate of trabeculectomy was higher than AGV in the surgical management of glaucoma in FUS during a medium-term follow-up.

Clinical observation on conjunctival incision leakage at early stage after trabeculectomy

Objective To investigate the treatment and efficacy of conjunctival incision leakage at early stage after trabeculectomy. Methods The data of 67 eyes of 67 cases with conjunctival incision leakage after trabeculectomy from Jun. 2012 to Dec. 2017 was retrospectively analysed. The intraocular pressure and filtering blebs were observed for 3-6 months. Results Incision leakage occurred in 67 cases at 1 week postoperatively, intraocular pressure was 15-23 mmHg in 9 eyes (13.4%), 10-14 mmHg in 21 eyes (31.3%), 5- 9 mmHg in 37 eyes (55.26%) (1 mmHg=0.133 kPa). There were 43 eyes of shallow anterior chamber (64.2%), choroidal detachment in 17 eyes (25.4%). No other serious complication such as endophthalmitis or malignant glaucoma. The complications were treat with conservative treatment of pressure dressing or iodine burning, conjunctival resuture repair. The intraocular pressure was less than 15 mmHg in 23 eyes, 15-20 mmHg in 26 eyes, higher than 21 mmHg in 18 eyes. Conclusion The timely and standardized treatment for the conjunctival incision leakage is beneficial to reduce the occurrence of more serious complications, and is conducive to the formation of functional filtering blebs. Thereby the success rate of trabeculectomy is improved. Key words: Trabeculectomy; Conjunctival incision leakage; Clinical observation

Predictive value of early postoperative IOP and bleb morphology in Mitomycin-C augmented trabeculectomy.

Background: To determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy. Methods: In this prospective interventional case series, we analyzed for one year 80 consecutive primary open angle glaucoma patients who underwent mitomycin-augmented trabeculectomy. Bleb morphology was scored using the Indiana bleb appearance grading scale (IBAGS). Success was defined as IOP ≤15 mmHg at 12 months. We applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC). Results: The mean age of participants was 62±12.3 years in the success and 63.2±16.3 years in the failure group (P= 0.430) with equal gender distribution (P=0.911). IOPs on day 1, 7 and 30 were similar in both (P= 0.193, 0.639, and 0.238, respectively.) The AUC of IOP at day 1, day 7 and 30 for predicting a successful outcome was 0.355, 0.452, and 0.80, respectively. The AUC for bleb morphology parameters of bleb height, extension, and vascularization, on day 14 were 0.368, 0.408, and 0.549, respectively. Values for day 30 were 0.428, 0.563, and 0.654. IOP change from day 1 to day 30 was a good predictor of failure (AUC=0.838, 95% CI: 0.704 to 0.971) with a change of more than 3 mmHg predicting failure with a sensitivity of 82.5% (95% CI: 68 to 91%) and a specificity of 87.5% (95% CI: 53 to 98%). Conclusions: IOP on day 30 had a fair to good accuracy while bleb features failed to predict success except bleb vascularity that had a poor to fair accuracy. An IOP increase more than 3 mmHg during the first 30 days was a good predictor of failure.

Predictive value of early postoperative IOP and bleb morphology in Mitomycin-C augmented trabeculectomy

Background: To determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy. Methods: In this prospective interventional case series, we analyzed for one year 80 consecutive primary open angle glaucoma patients who underwent mitomycin-augmented trabeculectomy. Bleb morphology was scored using the Indiana bleb appearance grading scale (IBAGS). Success was defined as IOP ≤15 mmHg at 12 months. We applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC). Results: The mean age of participants was 62±12.3 years in the success and 63.2±16.3 years in the failure group (P= 0.430) with equal gender distribution (P=0.911). IOPs on day 1, 7 and 30 were similar in both (P= 0.193, 0.639, and 0.238, respectively.) The AUC of IOP at day 1, day 7 and 30 for predicting a successful outcome was 0.355, 0.452, and 0.80, respectively. The AUC for bleb morphology parameters of bleb height, extension, and vascularization, on day 14 were 0.368, 0.408, and 0.549, respectively. Values for day 30 were 0.428, 0.563, and 0.654. IOP change from day 1 to day 30 was a good predictor of failure (AUC=0.838, 95% CI: 0.704 to 0.971) with a change of more than 3 mmHg predicting failure with a sensitivity of 82.5% (95% CI: 68 to 91%) and a specificity of 87.5% (95% CI: 53 to 98%). Conclusions: IOP on day 30 had a fair to good accuracy while bleb features failed to predict success except bleb vascularity that had a poor to fair accuracy. An IOP increase more than 3 mmHg during the first 30 days was a good predictor of failure.

Predictive value of early postoperative IOP and bleb morphology in Mitomycin-C augmented trabeculectomy

Background: Our aim was to determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy. Methods: In this prospective interventional case series, we analyzed for one year 80 consecutive primary open angle glaucoma patients who underwent mitomycin-augmented trabeculectomy. Bleb morphology was scored using the Indiana bleb appearance grading scale (IBAGS). Success was defined as IOP ≤15 mmHg with or without medications at 12 months. We tested for IOP and bleb morphological differences between groups, applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC). Results: Age and gender were equally distributed (62.3±13.1 years, P=0.911). IOP of patients with a successful outcome did not differ from unsuccessful ones on day 1, 7 and 30 (all P≥0.2). The AUC of IOP at day 1, day 7 and 30 for predicting a successful outcome was 0.355, 0.452, and 0.80, respectively. The AUC for bleb morphology parameters, bleb height, extension, and vascularization, on day 14 were 0.368, 0.408, and 0.549, respectively. Values for day 30 were 0.428, 0.563, and 0.654. IOP change from day 1 to day 30 was a good predictor of failure (AUC=0.838, 95% CI: 0.704 to 0.971) with a change of more than 3 mmHg predicting failure with a sensitivity of 82.5% (95% CI: 68 to 91%) and a specificity of 87.5% (95% CI: 53 to 98%). Conclusions: The postoperative IOP on day 30 had a fair to good accuracy while the bleb features failed to predict a successful outcome. An IOP increase by as little as more than 3 mmHg during the first 30 days was a good predictor of failure.

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

Objective: The aim of this study was to assess outcome of Trabeculectomy surgery in terms of preservation of intraocular pressure, visual acuity and optic nerve head defect among patient undergoing trabeculectomy surgery at university of Gondar tertiary eye care and training center. Methods: Hospital based cross sectional study was conducted from January to February 2017. A total of 69 consecutive ‘modern’ augmented and non-augmented ‘safe-technique’ trabeculectomies performed over a 2-year period (2012-2014) were assessed. Patients’ data from the charts were extracted and analyzed by SPSS version 20. Descriptive statistics were done to summarize the data. Paired samples t-test was performed to compare the correspondent preoperative and postoperative IOP, VA and CDR. P-value<0.05% was considered as statistically significant. Results: A total of 69 eyes of 63 patients having post-operative follow up of six months were included in the study. The mean age at the presentation was 59.12 ± 12.64 years. On the last day before surgery, mean snellen VA was 0.28 (± 0.23) and it was changed to 0.24 (± 0.20) p=0.38, mean IOP was 31.87 mmHg (± 10.08) and it was reduced to 18.45 mmHg (± 6.12) p=0.001, mean CDR was 0.84 mm (± 0.13) and was changed to 0.85 mm (± 0.12), p=0.009 at six months after surgery. Complete success and failure of trabeculectomy was 52 (75.4%) and 8 (11.6%), respectively. Conclusion: Based on IOP, the success rate of trabeculectomy was 75.4%. The mean preoperative VA was dropped by one line at six month after surgery and there was significant reduction of IOP from its base line.