Moderne Filtrationschirurgie

Abstract

Preoperative treatment with steroids and nonsteroidal anti-inflammatory drugs increases the success of filtration surgery. Surgery with the patient under subconjunctival anesthesia is safe. Intraoperative application of mitomycin C is state of the art and enhances success rates. Perioperative use of bevacizumab seems to attenuate postoperative fibrosis. Postoperative hypotension is avoided by stable fixation of the scleral flap followed by stepwise controlled suturelysis or release. Transconjunctival flap suturing allows fast and simple treatment of overfiltration. The shorter the time lag between trabeculectomy and subsequent cataract surgery the higher the probability of bleb failure will be. The number of antiglaucomatous drugs and severity of glaucomatous damage before surgery correlate with the probability of failure and blindness.

Efficacy and safety of preoperative IOP reduction using a preservative-free fixed combination of dorzolamide/timolol eye drops versus oral acetazolamide and dexamethasone eye drops and assessment of the clinical outcome of trabeculectomy in glaucoma

“…The currently used preoperative preparation in Mainz and other centres [ 12 ] has several potential disadvantages [ 13 – 15 ] We therefore sought an alternative preoperative treatment that would be better tolerated by patients in terms of safety and quality of life, that would require less visits to the ophthalmologist and general practitioner and would therefore be cheaper, and is that would be equally effective in reducing IOP three and six months after trabeculectomy. No treatment guidelines yet exist for the pretreatment prior to trabeculectomy.…”

“…No treatment guidelines yet exist for the pretreatment prior to trabeculectomy. Following recommendations by Klink et al [ 12 ], we decided to use preservative-free ß-blockers and/ or carbonic anhydrase inhibitors as a comparator.…”

Preoperative Preparation and Anesthesia for Trabeculectomy

“… 56 A recent review article on ‘modern filtration surgery’ concluded that ‘subconjunctival anesthesia is safe’. 59 …”

“… 1 Thus, current evidence indicates that anesthesia technique has no major effect on postoperative complication rate. 2 59 …”

“…The technique gives good operating conditions, good patient satisfaction, and fears about excess bleb failure or leakage have proved unfounded. 1 59 It can be used for primary or revision trabeculectomies, tube surgery, and is also suitable for trainee surgeons.…”