Trabeculectomy For Primary Open-angle Glaucoma Research Articles

Role of early trabeculectomy in primary open-angle glaucoma in the developing world

The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients. A total of 60 patients with moderately advanced POAG were randomised into three groups (Group I-Conventional medical management, Group II-Option for early trabeculectomy, Group III-Received an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction. The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (P<0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction. There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: Three-year prospective randomized clinical trial

Purpose: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). Setting: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. Methods: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. Results: At 3 years, the mean IOP was 16.0 mm Hg ± 7.07 (SD) in the trabeculectomy group and 17.8 ± 4.6 mm Hg in the viscocanalostomy group ( P = .694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group ( P>.05). Qualified success (IOP 6 to 21 mm Hg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group ( P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group ( P = .002). Conclusions: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Lens fluorophotometry after trabeculectomy in primary open-angle glaucoma

Objective To evaluate the loss of lens transparency incurred by patients undergoing trabeculectomy. Design A prospective cohort study. Participants and controls Data corresponding to 33 eyes of 33 consecutive patients with primary open-angle glaucoma (POAG) subjected to trabeculectomy (group 1) were compared with those corresponding to 12 eyes of 12 patients with POAG receiving topical antiglaucomatous treatment (group 2). Intervention Lens fluorophotometry was performed on the group 1 patients before and 12 months after surgery. In group 2, fluorophotometry was conducted at the onset of the study and at 12 months of follow-up. Main outcome measures Starting and final lens autofluorescence and transmittance values corresponding to each subject group were compared. Results In group 1, starting and final autofluorescence was 556.3 ± 184.3 and 691.1 ± 179.3 Eq ng/ml, and starting and final transmittance was 0.78 ± 0.11 and 0.67 ± 0.14, respectively. Respective values for group 2 were 574.3 ± 94.8 and 595.2 ± 107.0 Eq ng/ml and 0.72 ± 0.17 and 0.71 ± 0.16. The mean change between final and initial autofluorescence was statistically different between groups (134.7 ± 123.7, group 1, 20.9 ± 25.1 Eq ng/ml, group 2; P < 0.001). Similarly, a significant difference ( P < 0.001) in transmittance change was observed between the surgery and control groups (−0.11 ± 0.072, group 1; 0.02 ± 0.008, group 2) Conclusions It was demonstrated by lens fluorophotometry that trabeculectomy in POAG leads to a loss in lens transparency.

Long-term follow-up of initial 5-fluorouracil trabeculectomy in primary open-angle glaucoma in Japanese patients.

To evaluate the long-term efficacy and safety of initial trabeculectomy with subconjunctival 5-fluorouracil in Japanese patients with primary open-angle glaucoma. Clinical records of 117 eyes from 117 patients with records of up to 14 years were retrospectively analyzed using the appropriate statistical methods. The mean follow-up period was 6.2 +/- 3.6 years. Criteria for successful intraocular pressure control and success probability by Kaplan-Meier method at 12 years were intraocular pressure < 21 mm Hg without medication plus a 30% or more reduction in intraocular pressure, 50.4 +/- 5.2% (SE) 38.2 +/- 5.3%; and intraocular pressure < 16 mm Hg without medication plus a 30% or more reduction in intraocular pressure, 45.9 +/- 5.1% (36.5 +/- 5.2%). Cox multiple regression analysis showed that a younger age was associated with a higher success probability (P <0.01). Eyes with lower postoperative intraocular pressure tended to show more positive value of the MD slope (P = 0.0669), whereas 7% of successfully treated eyes showed a negative postoperative MD slope (P < 0.1). The probabilities for developing bleb leaks and bleb-related infections in eyes with a functioning bleb were 28.9 +/- 12.5% and 13.0 +/- 10.4% at 12 years. Trabeculectomy with 5-fluorouracil as an initial surgery in Japanese patients with primary open-angle glaucoma was effective for long-term control of glaucoma. However, the probability of late-onset bleb-related complications was not low in eyes with a functioning bleb, stressing the importance of constant care regarding bleb status.

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open- angle glaucoma

Objective To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma. Design Prospective randomized trial. Participants Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study. Intervention Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye. Main outcome measures Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications. Results At 12 months, mean IOP reduction was 12.3 ± 4.2 (sclerectomy) versus 14.1 ± 6.4 mmHg (trabeculectomy) ( P = 0.15), and an IOP ≤ 21 mmHg was achieved in 36 (92.3%) and 37 eyes (94.9%) ( P = 0.9), respectively. Complications included three (7.7%) flat/shallow anterior chambers and one (2.6%) hypotony (trabeculectomy), whereas internal iris incarceration was encountered in two eyes (5.1%) (sclerectomy). Conclusions Deep sclerectomy may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.

Age over 46 years does not affect the pressure lowering effect of trabeculectomy in primary open angle glaucoma

BACKGROUND/AIMSPrevious reports have suggested that the success rate for trabeculectomy is poorer in younger age groups but these studies often have heterogeneous groups representing different types of glaucoma with variable...

Penicillin-resistant Streptococcus pneumoniae Endophthalmitis

To report a case of trabeculectomy-associated endophthalmitis caused by penicillin-resistant Streptococcus pneumoniae. Case report. The patient developed endophthalmitis 1 month after an uncomplicated trabeculectomy for primary open-angle glaucoma. Vitreous cultures grew abundant, highly penicillin-resistant S pneumoniae. Despite aggressive treatment with vitrectomy and intravitreal injections of vancomycin hydrochloride and amikacin sulfate, the patient had a poor visual outcome. Penicillin-resistant S pneumoniae can cause endophthalmitis after trabeculectomy.

Outcomes of Trabeculectomy for Primary Open-angle Glaucoma

Purpose: To determine the long-term functional and structural outcomes in patients treated with trabeculectomy for primary open-angle glaucoma.Methods: Records of 78 consecutive patients (78 eyes) who had their first trabeculectomy were studied retrospectively (duration of follow-up, 25 to 112 months). Serial automated perimetry and stereoscopic optic disc photographs were used to assess the long-term efficacy of trabeculectomy to prevent progressive glaucomatous damage. Stereoscopic optic disc photographs were available for 29 eyes (38%). Criteria for intraocular pressure control were a minimum intraocular pressure reduction of 20% and intraocular pressure at or below 20 mmHg.Results: There was no evidence of progression of glaucomatous damage in 81 and 65% of the eyes after 3 and 6 years, respectively. The visual field deteriorated in 16 eyes (21 %) and progressive structural optic nerve damage occurred in 4 eyes (5%) during follow-up. Deterioration of the optic nerve head in the absence of visual field progression was detected in three (4%) of those eyes. In 19 eyes (25%), further glaucoma surgery was performed. The probability of successfulintraocular pressure control after a single operation was 48% and 40% at 3 and 5 years, respectively.Conclusion: Progressive glaucomatous damage occurs in about one third of eyes with moderate to severe primary open-angle glaucoma over a 6-year follow-up after trabeculectomy.

Trabeculectomy with 5‐fluorouracil

The effect of subconjunctival injection of 5-fluorouracil (5-FU) after trabeculectomy was studied retrospectively in 205 eyes of 168 patients. A life table analysis of the surgical outcome was based on the type of glaucoma and age related differences, and a comparison was made with patients who had trabeculectomy without subconjunctival 5-FU. The success rate at 30 months after trabeculectomy with 5-FU therapy was considerably higher in primary open-angle glaucoma at 93.6% (72.7%), secondary glaucoma at 88.9% (72.4%), and refractory glaucoma at 72.2% (32.5%) with (or without) the use of ocular hypotensive drops when compared with historical control groups treated without 5-FU (60.0% (41.7%), 35.5% (24.0%), and 18.0% (8.0%), respectively). In patients aged over 70 years, no statistically significant improvement could be demonstrated with the use of 5-FU after trabeculectomy in primary open-angle glaucoma. Our study may provide data on the appropriate dosage and indications for the use of this drug after glaucoma surgery.