The long-term outcome of glaucoma filtration surgery

Parc, C.; Johnson, Douglas H.; Oliver, Jessica E.; Hattenhauer, Matthew G.; Hodge, David O.

doi:10.1016/s0002-9394(01)00923-0

Cited by 73 publications

(54 citation statements)

References 22 publications

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“…However, if only phakic patients were considered, the rate increased to 42.9%, which falls within the range of cataract formation or progression reported in the literature. 28,29 There was no significant difference between the rates of cataract development, progression, or cataract operation after trabeculectomy between the Asian American and Caucasian groups. It is possible that both the Asian Americans and Caucasian patients in our tertiary care setting were more receptive to the option of cataract surgery.…”

Section: Discussionmentioning

confidence: 86%

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

Law

Modjtahedi

Mansury

2005

Eye

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Purpose Compare the efficacy and survival of trabeculectomy with intraoperative mitomycin-C (MMC) between Asian American and Caucasian patients in the same clinical setting. Methods In total, 29 Asian American patients (29 eyes) with trabeculectomies were matched case to case with 29 Caucasian patients (29 eyes) retrospectively. Matching criteria included age, glaucoma subtype, and preoperative intraocular pressure (IOP), gender, surgeon, ocular history, and glaucoma medications. Criteria of success included: (1) Final IOP 45 and o22 mmHg, (2) IOP reduction Z20%, or final IOP r10 mmHg, and (3) without additional glaucoma surgery, loss of light perception, or complication. Results Mean follow-up durations of Asian American and Caucasian group were 40.11722.5 months and 38.8717.7 months, respectively (P ¼ 0.81). At the final visits, IOP decreased from 18.776.1 to 10.974.0 mmHg (Po0.0001) in the Asian American group, and from 19.075.5 to 11.073.8 mmHg (Po0.0001) in the Caucasian group. There were no significant differences between the two groups in IOP levels at 6 months, 1 year, and final visits. The probabilities of trabeculectomy survival (continuing to meet definition of success criteria) at 12 and 48 months were 75.9 and 56.6% in the Asian American group and 82.8 and 66.6% in the Caucasian group, respectively. (P ¼ 0.46) There were no significant differences for rates of surgical success, failure, complication, vision decrease, hypotony, and cataract development. Patients who had episodes of hypotony had a higher rate of diagnosis of low-tension glaucoma subtype (P ¼ 0.02). Conclusions In a case-controlled comparison of an intermediate-term follow-up of trabeculectomy with intraoperative MMC, Asian American patients have a similar efficacy and survival probability as Caucasian patients.

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Section: Discussionmentioning

confidence: 86%

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

Law

Modjtahedi

Mansury

2005

Eye

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“…We observed progression of glaucomatous field defects in 41% of the eyes during the follow-up of 2-5 years (mean 3.5 years) after trabeculectomy. Progression rates of VF defects have varied considerably, partly due to different criteria of VF loss, partly due to different length of follow-up; the probability of progressive field loss at 4-5 years' follow-up has been reported in 25-27% [22,23], at 7-10 years in 27-76% [4,11,20,25,27] and at 11-15 years in 46-68% [15,21]. The fairly high progression rate in our series may be explained partly by the high proportion of severe VF defects before surgery (40% of preoperative VFs) and, partly, by One eye fulfilled also VF criteria for blindness too high postoperative IOP level.…”

Section: Discussionmentioning

confidence: 99%

Progression of visual field defects and visual loss in trabeculectomized eyes

Ehrnrooth

Puska

Lehto

et al. 2005

Graefe's Arch Clin Exp Ophthalmol

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Progression of VF defects and development of visual impairment due to glaucoma was fairly common despite trabeculectomy. Both were associated with severity of initial VF defect. In this series, no significant correlation appeared between defect progression and the last IOP, but association between stability of VF and the amount of IOP reduction after surgery indicate that a lower target IOP level particularly in eyes with initially severe VF defect would, however, be needed.

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“…38 Parc et al reported that 46% of posttrabeculectomy eyes that went blind had an IOP of 14 mm Hg compared to a mean of 15.4 mm Hg in those eyes not going blind. 39 CIGTS showed that despite a 48% reduction in IOP in the trabeculectomy eyes, there was more visual field loss progression in this group than that occurred in the medically treated eyes, which only had a 35% reduction in IOP. 40 Even in the Moorfields' Primary Treatment Trial, when fields were tested with automated perimetry, there was no difference in progression of field loss between the medically treated eyes (mean IOP of 19 mm Hg) and the trabeculectomy eyes (mean IOP of 14 mm Hg).…”

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confidence: 82%

Trabeculectomy is not the best surgical option for glaucoma

Wishart

2008

Eye

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The goal of glaucoma surgery should be the preservation of visual function, the avoidance of sight-threatening complications, and the preservation of the quality of life of the patient. Curiously, the majority of glaucoma surgeons still consider trabeculectomy the best surgical option for their patients, despite evidence that trabeculectomy cannot meet these goals.The trabeculectomy operation has already been abandoned in favour of the augmented trabeculectomy with the antimetabolite mitomycin-C (MMC) 1 by the majority of UK and US glaucoma specialists. 2 MMC trabeculectomy, however, is not safe. The risk of bleb-related endophthalmitis (BRE) ranges from 1.5% per patient year 3 to 10% in one year, 4 with 11 recent studies giving an average incidence of 2.8% per year. [5][6][7][8][9][10][11][12][13] As the mean follow-up of these 11 studies was 19 months, the true incidence may be higher, as institutional reviews of BRE show that the mean time of presentation of BRE is 32 months postoperatively. [14][15][16][17][18] Of equal importance as a cause of central visual loss after MMC trabeculectomy is hypotony maculopathy, with a mean incidence of 3.2% per annum reported in 7 recent studies (mean follow-up of 28 months). 4,9,[19][20][21][22][23] The Collaborative Initial Glaucoma Treatment Study (CIGTS) showed that trabeculectomy increases the risk of cataract formation eightfold in the first postoperative year and by fourfold over 5 years. 24 Cataracts can be removed, but bleb failure occurs in 22% of eyes as a consequence of cataract surgery. 25 Numerous papers are published advising techniques for increasing the safety of MMC trabeculectomy, with posterior application of MMC and strategies to avoid early postoperative hypotony using tight sutures that can later be released, lasered, or adjusted. 26 However, these postoperative manipulations can cause serious complications, such as endophthalmitis, bleb leaks, suprachoroidal haemorrhage, flat anterior chambers, 15,27,28 and may reduce the success of the operation. 29 A 2006 study described a 'Safe trabeculectomy technique' that had a 1.5% rate of BRE in the first year. 13 A recent editorial 30 on the Tube vs Trabeculectomy (TVT) study 31 described as 'excellent' the first year's results of MMC trabeculectomy despite persistent hypotony causing 3% of failures, 1% of eyes suffering BRE, and an additional 2% of cases suffering blebitis, 32 a precursor of endophthalmitis. 14 Surely such a high incidence of serious bleb-related complications is at odds with the description of an 'excellent record'?As to efficacy, MMC trabeculectomy in the TVT study had a 13.5% failure rate and a 57% incidence of postoperative complications, including a 10% incidence of shallow or flat anterior chamber, 3% hypotony maculopathy, 3% suprachoroidal haemorrhage, and 19% choroidal effusions. 31,32 There were 85 surgically invasive postoperative interventions including 49% laser suture lysis and 22% needling. 31 Two recent studies of MMC trabeculectomy from Europe showed similar rates of postop...

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The long-term outcome of glaucoma filtration surgery

Cited by 73 publications

References 22 publications

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

Progression of visual field defects and visual loss in trabeculectomized eyes

Trabeculectomy is not the best surgical option for glaucoma

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