Is the role of trabeculectomy in glaucoma management changing?

Whittaker, Karl W; Gillow, J T; Cunliffe, I A

doi:10.1038/eye.2001.153

Cited by 27 publications

(21 citation statements)

References 11 publications

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“…The issues of surgical exposure and learning effects have been discussed recently in the context of the declining numbers of glaucoma operations. 25 The UK National Trabeculectomy Study 26 highlights the importance of adequate supervision and training. Nonconsultant career grade surgeons achieved lower success rate than other surgeons groups, but no difference was found between junior ophthalmology trainees and fully qualified surgeons.…”

Section: Discussionmentioning

confidence: 99%

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Birchall

Bedggood

Wells

2006

Eye

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Aim To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures Methods Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 Â 4 mm, 16 mm 2 , n ¼ 12) or small scleral flaps (3 Â 2 mm, 6 mm 2 , n ¼ 9) were constructed over 0.76 mm 2 sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. Results Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n ¼ 8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n ¼ 8) flaps (unpaired t-test, P ¼ 0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD ¼ 12.7,.6%) for large and small flap groups, respectively (unpaired ttest, P ¼ 0.2). Conclusions Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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Section: Discussionmentioning

confidence: 99%

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Birchall

Bedggood

Wells

2006

Eye

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“…[3][4][5][6][7][8][9][10] Similarly, two studies have reported reductions in the total number of patients undergoing trabeculectomy in England over the past decade. 11,12 Whittaker et al 11 showed from Hospital Episode Statistics (HES, described below) that the annual number of patients undergoing trabeculectomy in England increased year on year from 10 115 (1989-1990) to 18 928 (1995-1996), then decreased year on year to 14 507 (1997-1998). More recently, Fraser et al 12 used HES data collected in a newer format to show that the annual number of patients undergoing trabeculectomy decreased year on year from 8622 (1998-9) to 4206 (2003-4).…”

Section: Introductionmentioning

confidence: 99%

Trends in rates of trabeculectomy in England

Keenan¹,

Salmon²,

Yeates

et al. 2008

Eye

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“…4 As a result, over the same period there has been a steady decline in the number of trabeculectomies being performed. 4,5 This is occurring during a time when higher surgical trainees (HST) are expected to perform a set number of glaucoma procedures. 6 The use of antimetabolites intraand postoperatively has increased considerably since 1996 with more aggressive postoperative management of the failed trabeculectomy bleb.…”

Section: Introductionmentioning

confidence: 99%