Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital

Abstract

Background:To determine the incidence of early postoperative complications and associated factors after primary trabeculectomy in Thai glaucoma patients.Design:This was a retrospective observational study performed in Chiang Mai University Hospital.Participants:One hundred and eighteen glaucoma patients participated in the study.Methods:All glaucoma patients underwent primary trabeculectomy with mitomycin C (MMC) using fornix-based conjunctival flap technique between December 2011 and May 2013. Surgical complications during the first 3 months of follow-up were recorded, and associated risk factors were analyzed.Main Outcome Measures:The incidence of posttrabeculectomy complications was the main outcome measure.Results:One hundred and eighteen eyes of 118 patients were included. Early postoperative complications developed in 55 eyes (56.7%). Complications included hypotony (25 eyes, 27.2%), serous choroidal detachment (CD) (14 eyes, 15.6%), subconjunctival hemorrhage (12 eyes, 13.0%), hyphema (11 eyes, 12.4%), bleb leak (8 eyes, 8.8%), encapsulated bleb (2 eyes, 2.2%), aqueous misdirection (1 eyes, 1.1%), corneal epithelial defect (1 eyes, 1.1%), and overfiltration (1 eyes, 1.1%). There were no reported cases of endophthalmitis or blebitis. Hypotony was associated with serous CD (P = 0.006), and hyphema was associated with neovascular glaucoma (NVG) patients (P = 0.009). NVG was not associated with the increased rate of surgical failure (P = 0.083).Conclusions:The incidence of early complications after first-time trabeculectomy with MMC was high (56.7%) in this Thai clinic setting, but most were transient and self-limited conditions. The correlations between hypotony and CD as well as hyphema and NVG were compatible with the previous studies.

Epidemiological pattern of Primary Congenital Glaucoma among Egyptian Children aged 0-4 years Attending Minoufia University hospital

“…In this study, 6% had post-operative hypotony while 2% developed choroidal hypotony. The result is consistent with another study conducted in Chiang Mai university hospital, where primary trabeculectomy with mitomycin C was associated with 27.2% hypotony after 3 months of operation (28) .…”

“…Some studies had reported post-operative long period hypotony with a mean follow up of 53.4 ± 31.4 months (30) . Ahmed valve can detain hypotony and choroidal hypotony to its least (31) .Choroidal hypotony, retinal detachment, hemorrhage are common after cyclo-destructive procedure (17,27,28) . Choroidal detachment was the highest among older patients after trabeculectomy as reported in the Collaborative Initial Glaucoma Treatment Study (CIGTS) (17,27) .…”

Effect of Trabeculectomy on the Ocular Higher Order Aberrations in Patients with Open Angle Glaucoma

“…A prospective study found that 1 week after trabeculectomy surgery, 94% and 43% of patients reported a change in their uncorrected and corrected Snellen visual acuity, respectively [ 17 ]. Some studies have attributed these alterations in visual acuity to changes in corneal contour, anterior chamber depth, axial length of the globe, and thickness of the crystalline lens [ 6 , 18 - 23 ]. Another study demonstrated with vector analysis that the cylinder component of refraction was increased by 1.4 D; however, the vector power of surgically induced refractive change at 1 month postoperatively did not significantly correlate with corneal coma-like, spherical-like, or total RMS, suggesting that changes other than anterior corneal aberration, such as internal optics of the eye, play a role in the changes in higher-order aberrations postoperatively[ 14 ].…”

Choroidal detachments: what do optometrists need to know?

“…49 The large majority of cases will resolve within 7-10 days through medical treatment alone and observation should be directed at restoration of anterior chamber depth, as the choroidal detachment settles itself afterwards. 14,104 Conservative management leads to better visual outcomes. 105 Recovery of the choroidal detachment following treatment occur on average 5.7 days after cessation of topical medication and with steroidal eye drops.…”