Simultaneous bilateral trabeculectomy

Abstract

In a retrospective study, 24 patients who had undergone simultaneous bilateral trabeculectomy over a 6-year period were reviewed. The duration of disease was at least 2 years, indicating that surgery was not performed as a primary procedure. No patients suffered complications leading to bilateral blindness, although 6 (25%) patients had reduced vision in both eyes at the first postoperative visit, with 3 (13%) worse than 6/36 binocularly. There was no evidence of an asymmetric response in the fall in intraocular pressure following trabeculectomy, after a mean follow-up of over 3 years. Compared with a matched group of patients undergoing unilateral trabeculectomy, the simultaneous bilateral group had a similar period of hospital stay. However, this was no shorter than that found in a group having staged bilateral surgery during the same admission, over the same study period. When separate admissions were required for bilateral drainage operations, though, there was a significant increase in the total length of inpatient stay. No convincing advantage was found for simultaneous bilateral trabeculectomy.

Outcome of consecutive trabeculectomy

“…Our results are in agreement with those of Hugkulstone et al. who reported symmetrical reduction of IOP following bilateral trabeculectomy 9 , and Mietz et al. who also found that primary trabeculectomies performed in both eyes of patients have a remarkably similar clinical course but that the second operated eye has a greater risk of Tenon's capsule cyst formation 12 .…”

“…In a study on simultaneous bilateral trabeculectomy, Hugkulstone et al. reported no difference in the outcome between the paired operated eyes 9 ; however, in both of these studies adjunctive antifibrotic therapy had not been used with the filtering surgery.…”

“…In conclusion, our study further supports the observations previously reported 8,9,12 that primary trabeculectomies performed in both eyes of patients have a similar clinical course. Thus, trabeculectomy outcome in the first operated eye can predict the surgical result in the second operated eye of the same patient.…”

Intraocular pressure control following microtrabeculectomy

“…A previous report from our unit has shown that there is no significant asymmetry between lOPs recorded from right and left eyes of individuals undergoing surgery to both eyes at the 12 o'clock position. 19 It is therefore unlikely that our surgical bias where all but two right eyes had temporal surgery was influential. Unlike Sanders et at.…”

Simultaneous bilateral intraocular surgery in children

“…The reluctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications, such as endophthalmitis, expulsive hemorrhage, or retinal detachment. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] SBIS has been performed in tens of thousands of adult patients, 2,17 with rare reports of bilateral complications. 4,[18][19][20][21][22][23][24][25] There are few reports of SBIS in children in the literature, with a total of 163 cases of bilateral cataract surgeries in children up to 19 years of age and a similar number of cases of bilateral congenital glaucoma surgery (either goniotomy or primary combined trabeculotomy/trabeculectomy).…”