Use Of Topical Beta-blockers Research Articles

Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

ObjectiveTo evaluate risk factors for intraocular pressure (IOP) spike following cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DesignRetrospective clinical cohort study. SubjectsAdults with IRIS® Registry data who underwent stand-alone phacoemulsification from January 1, 2013 to September 30, 2019. MethodsIOP spike was defined as a postoperative IOP >30 mmHg and >10 mmHg from baseline within the first postoperative week. Odds ratios (OR) for demographic and clinical characteristics were calculated with univariate and multivariate logistic regression analyses. Main Outcome MeasuresIncidence and OR of IOP spike. ResultsWe analyzed data from 1,191,034 eyes (mean age 71.3 years, 61.2% female sex and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma and 3.2% of eyes without glaucoma (P<0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR 1.57 per 3 mmHg), male sex (OR 1.79), glaucoma (OR 1.19), Black race (OR 1.39 compared to Asian and OR 1.21 compared to Hispanic), older age (OR 1.07 per 10 years), and complex surgery coding (OR 1.22, all P<0.0001). Diabetes (OR 0.90) and aphakia after surgery (OR 0.60) appeared to be protective against IOP spike (both P<0.0001). Compared to glaucoma suspects, there was a greater risk of IOP spike with ocular hypertension (OR 1.55), pigmentary glaucoma (OR 1.56), and pseudoexfoliative glaucoma (OR 1.52), and less risk for normal tension glaucoma (OR 0.55), primary angle closure (PAC) suspect (OR 0.67), and PAC glaucoma (OR 0.81, all P<0.0001). More baseline glaucoma medications was associated with IOP spike (OR 1.18 per medicine) while topical beta-blocker use (OR 0.68) was protective (both P<0.0001). ConclusionsHigher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with an early postoperative IOP spike whereas diabetes and postoperative aphakia were protective against a spike following stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on subtype of glaucoma. The findings may help surgeons stratify and mitigate the risk of IOP spike after cataract surgery.

It never happens, until it happens

An 86-year-old female patient was treated at home after having suffered a syncopal episode preceded by intermittent dyspnea in the previous weeks. Upon admission, the electrocardiogram showed Mobitz 2 second-degree AV (atrioventricular) block. Our patient suffered from systemic hypertension and chronic open-angle glaucoma, treated, respectively, with losartan 100 mg/hydrochlorthiazise 25 mg every 24 h and timolol 0.5% two times a day (introduced three weeks before after being assessed by ophthalmology service at another hospital center). Dyspnea and electrocardiographic blockage signs stopped once ocular beta blockers (timolol) were discontinued. Ocular topical administration is usually the preferred route for drug supply in ophthalmology and especially in glaucoma treatment, but it is not devoid of interactions and adverse effects. The following clinical case describes how the use of topical beta blockers for the treatment of glaucoma may be at the origin of systemic beta-blockade in our patient, a not so common, yet described situation.

Evaluation of treatment response with color doppler ultrasonography in cases with primary open-angle glaucoma

Aims: Beta-blockers, the most frequently preferred drug group in glaucoma.Withcolor Doppler ultrasonography (CDU), the localization of retrobulbar vascular structures, their flow rates and directions, and the effects of the drugs used on the ocular circulation can be examined in a dynamic, reliable, and noninvasive way in less time than other techniques. The aim of our study was to compare the effects of beta-blockers, widely used in glaucoma treatment, and the additional neuroprotectant flunarizine on ocular hemodynamics using CDU. Methods: Between November 1998 and August 1999, 30 cases diagnosed with POAG in the GlaucomaUnit of the 1st EyeClinic of our center were included in the study. Patients were divided into 3 groups according to their beta-blocker treatment. Patients' CDU examinations were then examined by an experience dradiologist, and peaksys to lic flow velocity (PSFV) and end-diastolic flow velocity (EDFV) of the ophthalmicartery (OA), central retinal artery (CRA), and lateral (temporal) posterior ciliary arteries (LPCA) in the right or left eye were detected. Results: Of the 30 patients who participated in the study, 14 were male and 16 were female. Nine patients had hypertension (HT), 3 patients had diabetes (DM), and 6 patients had migraine. The mean age was similar in all three groups. There was a significant reduction in IOP in all three patient groups in whom IOP was measured after the use of topical beta-blockers (P&lt;0.01). The use of flunarizine had no effect on IOP in all three groups (P&gt;0.05). There was no statistically significant difference between groups in OA PSFVs and EDFVs at the first, second, and third measurements using the three beta-blockers (P&gt;0.05). No statistically significant difference existed between all three groups in the measurements of CRAPSFVs and EDFVs (P&gt;0.05). There were also no significant differences between groups in measurements of LPCA, PSFVs, and EDFVs at baseline and follow-up (P&gt;0.05). Conclusion: We found that the changes in hemodynamic parameters and reduction in IOP with all three beta-blockers were similar on color Doppler USG in patients using beta-blockers for the treatment of glaucoma. We observed that flunarizine had no effect on systemic hemodynamic parameters, did not affect IOP, and had no adverse effects on retrobulbar hemodynamic parameters when combined with beta-blockers. Local beta-blockers remain the mainstay of medical treatment for POAG because of their low systemic side effects and beneficial effects on the eye.

EFFICACY OF SUPRACHOROIDAL TRIAMCINOLONE ACETONIDE INJECTION IN THE TREATMENT OF RESISTANT DIABETIC MACULAR EDEMA

This study aimed to assess the efficacy of suprachoroidal TA injection for treating diabetic macular edema resistant to anti-VEGF agents. A prospective study was conducted in Ophthalmology Department Service Hospital, Lahore, from December 2020 to December 2021. A total of 60 patients were included in the study. Suprachoroidal TA injection 4 mg/0.1 mL was given after diagnosing resistant DME. The injection was administered every 3 months during the follow-up period (12 months) if intraretinal cysts, intraretinal or subretinal fluid persisted and CMT remained &gt; 250 µm. The primary endpoint was CMT reduction and BCVA improvement after 12 months of injection. The secondary endpoint was assessing the safety of TA injection. The mean CMT at baseline was 478.6±170.1 µm, and after 12 months, it was 230.1 ± 47.5 µm. This decrease was statistically significant (P&lt; .001). The mean BCVA at baseline was 1.194±0.1; after 12 months, it was 0.75±0.2 (P&lt;.001). After one month of injection, IOP reached the maximum value (13.2±0.4 mmHg) compared to the baseline (12.32±0.1mmHg). It gradually declined with the use of topical beta blockers and reached baseline value at 3rd month, and glaucoma surgery was not needed in any patient. Suprachoroidal TA injection effectively treats resistant DMA and leads to SCVA improvement and CMT reduction.

NIGHTMARES FROM TOPICAL TIMOLOL EYE DROPS: A CASE REPORT

Topical timolol eyedrops are frequently used as medical treatment of glaucoma. They decrease the production of aqueous humor by blocking the beta adrenergic receptors of ciliary body. Although systemic absorption of eyedrops is negligible, still it can cause some serious side effects like bradycardia, heart block, bronchospasm, confusion and hypotension. We present a case who developed nightmares with use of topical beta-blockers. He was a chronic case of primary open angle glaucoma whose target intraocular pressure (IOP) couldn’t be achieved with latanoprost alone, the first line drug, so we put him on topical timolol twice daily dosage to further decrease the IOP. On his follow-up visit he complained about bad dreams since starting timolol eye drops. This case report will add to the list of already known other side effects of timolol usage in glaucoma patients.

Association between topical beta-blockers and risks of cardiovascular and respiratory disease in patients with glaucoma: a retrospective cohort study

ObjectiveTo determine if topical beta-blocker use is associated with increased risks of cardiovascular and respiratory diseases in patients with glaucoma.SettingA retrospective cohort analysis was conducted using the database from Taiwan’s...

Cardiovascular and respiratory considerations with topical beta-blockers: is it really old news?

Objective The aim of this study was to identify the prevalence of prescribing topical beta-blockers (TBB) despite documented contraindications in general practice and whether patients were involved in decisions about treatment. Design This was a primary-care-based cross-sectional descriptive study. Introduction Glaucoma is one of the commonest causes of irreversible blindness in the United Kingdom, causing ∼5.9% of blind registration. TBB are currently considered the best adjunctive treatment and are well known for their systemic effects. The effect of concurrent prescription of TBB with systemic contraindications was found to significantly increase the rate of hospitalization and emergency room visits. Patients and methods Electronic medical records of four primary care providers in the North East of England were searched for primary open-angle glaucoma, use of TBB, and known systemic contraindications. Included records were further searched for correspondence from ophthalmology departments to primary care. We contacted those patients whose records showed no documentation of communicating potential risks with patients and rationale of using TBB. Results Of the 49 816 patients registered with the four primary health care providers, 798 (1.6%) had primary open-angle glaucoma. Of these, 279 (35%) were prescribed TBB; 260 (93.2%) of whom had no systemic contraindications. Conclusion Nineteen (6.8%) patients with systemic contraindications were prescribed TBB despite alerts from electronic medical records. Furthermore, these patients were not made aware of the potential risk.

Association of Postoperative Topical Prostaglandin Analog or Beta-Blocker Use and Incidence of Pseudophakic Cystoid Macular Edema.

The purpose of this article is to determine the association of postoperative topical prostaglandin analog (PGA) or topical beta-blocker use and the incidence of pseudophakic cystoid macular edema (CME). This was a nested case-control study. All adult patients who underwent cataract surgery between January 1, 2006 and December 31, 2016 and who were enrolled in the PharMetrics Plus database were eligible for inclusion. The association between postoperative topical PGAs (bimatoprost, latanoprost, and travoprost/travoprost-z) or beta-blocker (betaxolol, levobunolol, and timolol) use and the incidence of pseudophakic CME was assessed by conditional logistic regression. Five hundred eight cases and 5080 controls were included in the analyses. Incidence of pseudophakic CME was found to be statistically significantly associated with the current postoperative use of both topical PGAs [relative risk (RR), 1.86; 95% confidence interval (CI), 1.04-3.32] and topical beta-blockers (RR, 2.64; 95% CI, 1.08-6.49). Postoperative use of each of bimatoprost (RR, 2.73; 95% CI, 1.35%-5.53%) and travoprost/travoprost-z (RR, 3.16; 95% CI, 1.42-7.03) in the year before diagnosis was demonstrated to be statistically significantly associated with the incidence of pseudophakic CME. This association was not observed to be statistically significant with the postoperative use of latanoprost (RR, 1.55; 95% CI, 0.84-2.88). To the best of our knowledge this is the largest study that has investigated the association between postoperative topical PGA or topical beta-blocker use and the incidence of pseudophakic CME. Postoperative use of both topical PGAs and topical beta-blockers was found to be associated with the incidence of pseudophakic CME.

Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study

ABSTRACTPurpose: To determine if topical beta-blocker use is associated with increased cardiovascular mortality, particularly among people with self-reported glaucoma.Methods: All participants who participated in the first health check (N = 25,639) of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort (1993–2013) were included in this prospective cohort study, with a median follow-up of 17.0 years. We determined use of topical beta-blockers at baseline through a self-reported questionnaire and prescription check at the first clinical visit. Cardiovascular mortality was ascertained through data linkage with the Office for National Statistics mortality database. Hazard ratios (HRs) were estimated using multivariable Cox regression models. Meta-analysis of the present study’s results together with other identified literature was performed using a random effects model.Results: We did not find an association between the use of topical beta-blockers and cardiovascular mortality (HR 0.93, 95% confidence interval, CI, 0.67–1.30). In the 514 participants with self-reported glaucoma, no association was found between the use of topical beta-blockers and cardiovascular mortality (HR 0.89, 95% CI 0.56–1.40). In the primary meta-analysis of four publications, there was no evidence of an association between the use of topical beta-blockers and cardiovascular mortality (pooled HR estimate 1.10, 95% CI 0.84–1.36).Conclusion: Topical beta-blockers do not appear to be associated with excess cardiovascular mortality. This evidence does not indicate that a change in current practice is warranted, although clinicians should continue to assess individual patients and their cardiovascular risk prior to commencing topical beta-blockers.

Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation

ObjectiveTo study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. MethodsA study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. ResultsIt was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880mW for 3s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. ConclusionNeurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.

Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo

ObjectiveTo study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. MethodsA study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. ResultsIt was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. ConclusionNeurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.

Dry eye syndrome in patients with primary open-angle glaucoma

to determine the frequency and severity of dry eye syndrome (DES) in primary open-angle glaucoma (POAG) patients that are newly diagnosed or already receiving beta blocker instillation therapy. A total of 127 patients (190 eyes) with POAG were divided into two groups. Group 1 included 55 newly diagnosed patients (88 eyes), group 2-72 POAG patients (102 eyes) instilling timolol 0.5% twice daily into the affected eye. The control group included 20 patients (40 eyes) aged 60-88 years (73.6 ± 9.2 years on average) with early age-related cataract. DES was found in 69 POAG patients (79%) who was just starting their topical hypotensive therapy and 85 of those (84%) under treatment (p = 0.39). One should take into account when prescribing ocular hypotensive therapy that newly diagnosed POAG patients usually already suffer from a dry eye. The use of topical beta blockers that contain preservatives exacerbates dry eye signs and symptoms in these patients.

Does the use of preoperative antiglaucoma medications influence trabeculectomy success?

To investigate the influence of preoperative antiglaucoma medications on trabeculectomy outcome. Two hundred fifteen eyes, which underwent primary trabeculectomy, were retrospectively analyzed. The average follow-up was 39.8±30.3 months. The only cases of primary open-angle glaucoma, with or without pseudoexfoliation (PXF), were included. "Complete success" was defined as intraocular pressure (IOP) <18 mmHg without glaucoma medications, whereas relative success was defined as the same IOP target with medications. The influence of the preoperatively used glaucoma medications on surgical success was analyzed by univariate Pearson correlation and multivariate (ordinal) regression analysis. There were 118 male (54.9%) and 97 female (45.1%) patients with a mean age of 66.9±9.3 years. PXF glaucoma (PXFG) was present in 93 eyes (43.3%). In 33 patients (15.3%), diabetes mellitus (DM) was present. Complete success was achieved in 116 eyes (54%), relative success in 81 eyes (37.6%), and failure in 18 eyes (8.4%). Neither the total number nor the duration of glaucoma medications used before trabeculectomy was found to have any statistically significant influence on surgical success. In statistical analysis, a combination of topical beta-blocker and carbonic anhydrase inhibitor (BB+CAI) used before surgery was found to be associated with statistically better outcome, whereas the preoperative use of topical beta-blockers alone could have a negative influence on success. PXF was shown to be independently associated with trabeculectomy outcome on multivariate regression analysis. The glaucoma medications used preoperatively were not found to have any statistically significant negative influence on the trabeculectomy outcome and use of the combined BB+CAI preparation could have a positive influence, whereas the use of topical beta-blockers alone could have a negative influence on success, although not statistically significant. The presence of PXF was independently associated with a better surgical outcome.

Inferior Field Loss Increases Rate of Falls in Older Adults with Glaucoma

To examine the visual predictors of falls and injurious falls among older adults with glaucoma. Prospective falls data were collected for 71 community-dwelling adults with primary open-angle glaucoma (mean age, 73.9 ± 5.7 years) for 1 year using monthly falls diaries. Baseline assessment of central visual function included high-contrast visual acuity and Pelli-Robson contrast sensitivity. Binocular integrated visual fields were derived from monocular Humphrey Field Analyzer plots. Rate ratios (RR) for falls and injurious falls with 95% confidence intervals (CIs) were based on negative binomial regression models. During the 1-year follow-up, 31 (44%) participants experienced at least one fall and 22 (31%) experienced falls that resulted in an injury. Greater visual impairment was associated with increased falls rate, independent of age and gender. In a multivariate model, more extensive field loss in the inferior region was associated with higher rate of falls (RR, 1.57; 95% CI, 1.06 to 2.32) and falls with injury (RR, 1.80; 95% CI, 1.12 to 2.98), adjusted for all other vision measures and potential confounding factors. Visual acuity, contrast sensitivity, and superior field loss were not associated with the rate of falls; topical beta-blocker use was also not associated with increased falls risk. Falls are common among older adults with glaucoma and occur more frequently in those with greater visual impairment, particularly in the inferior field region. This finding highlights the importance of the inferior visual field region in falls risk and assists in identifying older adults with glaucoma at risk of future falls, for whom potential interventions should be targeted.

Ocular Surface Disease and Quality of Life in Patients With Glaucoma

To investigate the relationship between ocular surface disease and glaucoma-related quality of life (QoL), glaucoma severity, and treatment in patients with open-angle glaucoma. Cross-sectional study. Clinical practice. One hundred twenty-four participants-patients with mild (n = 48), moderate (n = 34), or severe (n = 19) glaucoma and 23 controls (glaucoma suspects) not receiving glaucoma treatment-were enrolled. Severity was stratified according to binocular visual field loss. OBSERVED PROCEDURES: Demographic information, the Ocular Surface Disease Index (OSDI), and Glaucoma Quality of Life-15 (GQL-15) questionnaires were administered. OSDI score, GQL-15 score, number and type of glaucoma medications, daily dose of benzalkonium chloride (BAK), and visual field indices. OSDI scores and the number of patients with OSD increased with increasing glaucoma severity (P < .001 and P < .005). GQL-15 scores reflected decreased QoL with increasing glaucoma severity (P < .001). These trends were maintained after sub-stratification for age and sex. On univariate regression OSDI was significantly correlated with GQL-15 summary score, glaucoma severity, multiple topical glaucoma medications, worse eye mean deviation and pattern standard deviation, use of topical beta blockers, topical carbonic anhydrase inhibitors, daily dose of BAK, and glaucoma filtration surgery. On multivariate regression GQL-15 summary score (odds ratio [OR] 4.14, 95% confidence interval [CI] 2.59-6.63, P < .001) and a daily dose of BAK greater than 3 (OR 2.47, 95% CI 1.17-5.21, P = .018) were predictive of OSDI score. OSD is more common in patients with increasing glaucoma severity and is associated with poorer glaucoma-related QoL and higher exposure to BAK.

Topical β-Blockers and Mortality

To study the associations between long-term and short-term use of topical beta-blockers and mortality. Prospective population-based cohort study. To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484 incident beta-blocker users and 4700 age-matched controls were recruited. All participants were recruited as part of the Rotterdam Study. To examine long-term effects, associations between topical beta-blocker use before and at baseline, between 1990 and 1997, and mortality between 1997 and 2005 were studied. Data were analyzed using Cox regression, and hazard ratios were adjusted for age, gender, smoking, systemic hypertension, diabetes mellitus, and angina pectoris. Short-term effects were defined as death within 3 months after the first prescription of a topical beta-blocker. Mortality was compared between incident beta-blocker users, that is, participants who started using a topical beta-blocker between the onset of the Rotterdam Study in 1990 and October 1, 2004, and age-matched controls. Short-term effects were examined using a chi-square test. Confounding by smoking was analyzed by stratification. For long-term effects, hazard ratios of topical beta-blocker use for all-cause mortality and cardiovascular mortality; for short-term effects, chi-square statistics between mortality of incident topical beta-blocker users and age-matched controls. With regard to long-term effects, mean age at baseline was 72 years (standard deviation, 7 years). Topical beta-blockers were used by 228 participants. Seven hundred nine participants died during the follow-up (18%); 135 (3.5%) died of a cardiovascular cause. The hazard ratio of topical beta-blocker use was 0.94 (95% confidence interval [CI], 0.71-1.25; P = 0.69) for all-cause mortality and 1.02 (95% CI, 0.56-1.86; P = 0.95) for cardiovascular mortality. With regard to short-term effects, 4 (0.8%) of the 484 incident topical beta-blocker users died within 3 months after their first prescription; 65 (1.4%; P = 0.31) of the 4700 aged-matched controls died within a similar period. Use of topical beta-blockers seems not to be associated with excess mortality.

Topical β-Blockers Are Not Associated with an Increased Risk of Treatment for Depression

To investigate the effect of topical beta-blockers on the prevalence of depression among glaucoma patients. Retrospective observational population-based cohort study. We reviewed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (Central District of Clalit Health Services) who were older than 20 years (317,469 members). We documented all antiglaucoma prescriptions (n = 274,023) and all antidepressant prescriptions (n = 16,948) filled by glaucoma patients in the district between January 1, 2001 and December 31, 2003. We included only those patients who filled at least 6 consecutive antiglaucoma prescriptions at least once every 2 months (n = 6597; 5846 [88.6%] were treated with topical beta-blockers). Depressed patients were defined as patients that filled at least four prescriptions for antidepressants during the study period (n= 810, 12.3% of all glaucoma patients). Relationship of topical beta-blocker use and prevalence of depression among glaucoma patients. No significant demographic differences were noted between glaucoma patients treated and not treated with topical beta-blockers. Of those treated and not treated with beta-blockers, 12.2% (12.7% after age-adjustment) and 12.7%, respectively, were also receiving drug therapy for depression (P = 0.7, chi-square test). With stratification by age, treatment with topical beta-blockers did not influence the prevalence of depression in any age group. Logistic regression analysis revealed a significant effect of age, place of birth, and gender on the prevalence of depression, but the prevalence of use of topical beta-blockers had no significant effect. Use of topical beta-blockers by glaucoma patients does not appear to increase the risk of depression in this population.

1159 The use of topical betablockers can result in inconclusive dobutamine stress echocardiography in patients with glaucoma

1159 The use of topical betablockers can result in inconclusive dobutamine stress echocardiography in patients with glaucoma

Encapsulated blebs following primary standard trabeculectomy: course and treatment.

To investigate the incidence and course of encapsulated filtering blebs (EB) following primary standard trabeculectomy in eyes with non-complicated glaucoma. Records of patients who were being followed-up in Ankara Numune Hospital, 1st Eye Clinic Glaucoma Department were analyzed and 183 eyes of 183 consecutive patients who underwent primary trabeculectomy without antimetabolites were enrolled in the study. Encapsulation developed in 14 (7.6%) of 183 eyes and identification of bleb encapsulation occurred at a mean follow-up time of 5.1 +/- 5.0 weeks (median = 4 weeks). Mean intraocular pressure (IOP) levels before, during, and after the encapsulated bleb phase were 14.1 +/- 3.6, 23.4 +/- 6.9, and 14.4 +/- 3.9 mm Hg respectively. All eyes responded to conservative medical treatment consisting of aqueous suppressants without digital massage, and encapsulation resolved after a mean duration of 8.3 +/- 4.6 weeks (median = 8 weeks). Patient age, gender, glaucoma diagnosis, and preoperative IOP levels were not significantly related with the occurrence of EB formation. There was no significant difference in the use of topical beta-blockers and miotics in patients that developed EB versus those who did not; however, EB developed only in eyes with prior beta-blocker therapy and no encapsulation occurred in the 16 eyes that had not received topical beta-blockers. Mean duration of follow-up was 45.3 +/- 30.7 months (12 to 127 months) in the group without encapsulation and 44.6 +/- 22.7 months (18 to 84 months) in the EB group. Overall success rates of trabeculectomies in eyes with and without EB were not significantly different (100% and 91.7%, respectively). Complete surgical success, however, without antiglaucomatous medications at the last visit was significantly lower in eyes with prior encapsulation (35.7% with EB, 63.9% without EB) (P = 0.014). Filtering bleb encapsulation following primary trabeculectomy responds well to conservative medical IOP-lowering therapy in eyes with glaucoma associated with elevated IOP.