Systemic anti‐inflammatory fibrosis suppression in threatened trabeculectomy failure

Vote, Brendan J.; Fuller, J R; Bevin, Tui H; Molteno, A. C. B.

doi:10.1046/j.1442-9071.2004.00765.x

Cited by 39 publications

(27 citation statements)

References 36 publications

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“…14,23 The preoperative IOP was taken as the mean IOP in the month before surgery, and the postoperative IOP was taken as the mean IOP for each postoperative month. Successful IOP control was defined as an IOP of at least 6 mm Hg but not more than 21 mm Hg with or without hypotensive medication.…”

Section: O L T E N O I M P L a N T Smentioning

confidence: 99%

Otago Glaucoma Surgery Outcome Study

Thompson¹,

Molteno²,

Bevin³

et al. 2013

JAMA Ophthalmol

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To evaluate the efficacy of the 175-mm 2 Molteno3 implant in patients with nonneovascular glaucoma.Methods: A hospital-based, retrospective historical control comparative case series comparing results in the first 87 eyes to receive the 175-mm 2 Molteno3 implant with those in a control group of 115 eyes receiving the 274mm 2 double-plate Molteno implant.Results: Successwasdefinedasanintraocularpressure(IOP) of at least 6 mm Hg but not more than 21 mm Hg with or without hypotensive medication. The mean postoperative follow-up was 3.0 years (range, 13 days to 5.6 years) in the Molteno3 implant group and 6.2 years (range, 1 day to 13.9 years) in the double-plate Molteno implant group. The mean (SD) preoperative IOP was 25.6 (7.1) mm Hg in the Mol-teno3 implant group in eyes treated with a mean of 2.3 ocular hypotensive medications, and 25.7 (8.0) mm Hg in the double-plate Molteno implant group in eyes treated with a mean of 2.2 medications. The mean (SD) postoperative IOP at 36 months was 13.9 (3.2) mm Hg in the Molteno3 implant group in eyes treated with a mean of 0.9 ocular hypotensive medications, and 14.5 (3.4) mm Hg in the doubleplate group in eyes treated with a mean of 0.7 medications. The probability of IOP control at 3 years was 0.79 in both groups.Therewassignificantlymorepostoperativehypotony in eyes without a polyglactin 910 tie in the Molteno3 implant group (P=.04); however, significantly more eyes with flat anterior chambers in the double-plate group required anterior chamber reformation (P=.03). Conclusion:The 175-mm 2 Molteno3 implant provided intermediate-term successful treatment of nonneovascular glaucoma comparable to that provided by the double-plate Molteno implant.

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Section: O L T E N O I M P L a N T Smentioning

confidence: 99%

Otago Glaucoma Surgery Outcome Study

Thompson¹,

Molteno²,

Bevin³

et al. 2013

JAMA Ophthalmol

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“…Adequate control of postoperative inflammation is essential to ensure surgical success by maintaining bleb function, especially since early bleb failure often reflect excessive wound healing and subsequent closure of the filtering route (Vote et al. ).…”

Section: Introductionmentioning

confidence: 99%

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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Surgical outcome after trabeculectomy depends on maintaining a functional bleb which requires a delicate balance between incomplete wound healing to prevent fibrosis and enough wound healing to prevent hyperfiltration. Thus, controlling the inflammatory response is essential. We conducted a systematic review and meta-analysis to compare the effectiveness of different formulations of steroids (topical, systemic and depot) and nonsteroidal anti-inflammatory drugs (NSAIDs) in achieving long-term pressure control with fewer antiglaucomatous medications, preserving visual acuity and visual fields while considering surgical and postoperative complications. We used the PubMed, EMBASE and Cochrane Libraries to identify randomized controlled trials (RCTs) comparing the effect of different formulations of steroids (topical, systemic or depot) to NSAIDs. Data on prespecified outcomes from eligible references were entered into a meta-analysis using the Review Manager 5.3 program. We identified seven RCTs with a total of 342 included patients. Topical steroids were superior to placebo in controlling intraocular pressure (IOP) and reducing the risk of complications. Supplementing topical steroids with a perioperative steroid depot (subtenon or intracamerally) or systemic steroids in the early postoperative period did not provide better outcome or a change in the risk of complications. Addition of topical NSAIDs to topical steroids in patients undergoing trabeculectomy did not change the outcome or risk profile. For patients undergoing phacotrabeculectomy and topical NSAID, there was a nonsignificant trend towards better intermediate IOP control and a reduced need for antiglaucomatous medications compared to topical steroids but there was no difference in effect for patients undergoing trabeculectomy. In conclusion, there is a low level of evidence to support the clinician in deciding which postoperative regime provides a more favourable outcome because of inconsistency in the reported outcomes between studies and a low number of patients for each comparable intervention and outcome. It does seem that topical steroids are better than no antiinflammatory treatment after glaucoma surgery, but further research is recommended.The authors are grateful for the help of information specialist Karine Korsgaard with the literature search.

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“…The most important cause of persistent IOP elevation after trabeculectomy is unduly marked or persistent inflammation, followed by deposition of fibrous tissue, which prevents the formation of an adequately draining bleb [18]. Modifying the wound healing process of the scleral flap upon trabeculectomy could enhance the surgical outcome.…”

Section: Discussionmentioning

confidence: 99%

Subconjunctival Bevacizumab as an Adjunct to Trabeculectomy in Eyes with Refractory Glaucoma: A Case Series

Choi

Kim

2010

Korean J Ophthalmol

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This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5±14.4 mmHg, 6.2±3.4 mmHg, 8.3±7.2 mmHg, 12.0±4.4 mmHg, 10.8±3.1 mmHg, and 12.2±3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.

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Systemic anti‐inflammatory fibrosis suppression in threatened trabeculectomy failure

Cited by 39 publications

References 36 publications

Otago Glaucoma Surgery Outcome Study

Otago Glaucoma Surgery Outcome Study

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Subconjunctival Bevacizumab as an Adjunct to Trabeculectomy in Eyes with Refractory Glaucoma: A Case Series

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