The complications of trabeculectomy (a 20-year follow-up)

Abstract

SummaryThe complications of trabeculectomy were studied in two groups of patients taken from a stable white population. The first group who had had their operation when it was first introduced 22 years ago, had been previously treated with prolonged medi cation, the second group had been operated upon recently and had had short-term pre-operative medication. This study confirmed that trabeculectomy predictably reduces the intraocular pressure to within the accepted normal range and that the pressure level below which the intraocular pressure could not be expected to fall was £: 14 mm/Hg. It also revealed that although some post operative abnormality was noted in two-thirds of the patients there were no long term problems which could be related to any operative or immediately post-operative complications, including shallow anterior chambers, uveitis and hyphaema. However, there was a long term reduction in the visual acuity and visual fields of about one-third of the patients, which was not related to cataract formation, macular problems, the height of the preoperative intraocular pressure, the amount by which this fell as a result of the surgery, or the amount, length or type of preoperative medication given before the operation. Although there was some increase in cataracts throughout the whole long term group this was mainly in those who had cataract prior to surgery; the increase was not related to operations or any other factor other than corneo-Ienticular contact post-operatively.

South-East Scotland trabeculectomy survey

“…Reassuringly, other long-term studies indicate little correlation between early complications and long-term outcome. 14 In our survey, a comparison was made between the consultants and HST. Although it was not formally documented, in terms of patient selection the consultants tended to perform the more complicated cases (ie only eyes, advanced glaucoma, etc.).…”

The National Survey of Trabeculectomy. III. Early and late complications

“…Indeed, in a paper with the longest followup to date, Molteno reported that 42.9% of cases had lost more than one line of Snellen acuity and the probability of legal blindness was 0.4 at 15 years 20 and in Watson's 20-year follow-up paper more than two lines of Snellen acuity were lost in 30% of cases at final follow-up. 27 In this survey a significant number (18.8%) of patients had lost more than one line of bestcorrected Snellen acuity by 1 year after trabeculectomy. In a third of these cases no reason was given for the loss of acuity (Table 2).…”

A review of trabeculectomy in East Asian people—the influence of race

“…In a study of 150 eyes which had undergone unaugmented trabeculectomy with 9-year follow-up (predominantly white patients), 90% were controlled (IOPo20 mmHg no medication) at the last visit. 28 Chen et al 29 retrospectively reported a series of patients with various glaucoma diagnoses from a mixed white and black population, who underwent unaugmented primary trabeculectomies. In all, 40 patients were identified who had successful IOP control at 1 year (IOPo21 mmHg or 33% reduction).…”