The Norwich trabeculectomy study: risk factor analysis for the development of adverse, thin cystic blebs

Abstract

Purpose: To investigate potential risk factors, particularly antimetabolite choice, with regard to the development of adverse bleb morphology in eyes that had undergone trabeculectomy surgery. Methods: A single-centre, observational cohort study of 631 consecutive eyes, which had undergone trabeculectomy over an 11-year period. For each case, bleb morphology was recorded at 2 years, and its association with the per-operative antimetabolite as well as potential confounding risk factors was analysed using univariate (unadjusted) and multivariate (adjusted) logistical regression analyses to identify those that could contribute to the development of adverse blebs. A standard protocol for 5-fluorouracil and mitomycin-C utilization was employed in the majority of cases. Results: When 5-fluorouracil was used (n = 257), 24% of patients formed cystic or partially cystic blebs, whereas with mitomycin-C (n = 299), only 12% formed such adverse blebs, the difference being statistically significant (OR = 3.54, p = 0.002 unadjusted; OR = 7.49, p = 0.00 adjusted). Of the other potential confounding factors, care within the private sector (OR = 0.30 p = 0.02) and a history of previous ocular surgery involving a conjunctival incision were identified as potential risk factors for the formation of adverse cystic blebs (OR = 0.28, p = 0.02). Conclusions: Modern use of mitomycin-C appeared to be better than 5fluorouracil as an adjunctive antimetabolite used at the time of trabeculectomy, with respect to the development of preferable final bleb morphology. The only potential preoperative risk factors found to be significant with respect to adverse cystic bleb development were care in the private health sector and previous ocular surgery involving a conjunctival incision.

A bibliometric analysis of apoptosis in glaucoma

“…As a classic treatment for glaucoma (Olawoye and Etya'ale, 2021 ; Philippin et al, 2021 ), trabeculectomy appears 39 times, ranking as the second most frequent treatment keyword. In addition, trabeculectomy in combination with antimetabolites such as mitomycin-c (top three treatment keyword) or 5-fluorouracil (top 12 treatment keyword) has long been known to improve the prognosis for glaucoma treatment (Theventhiran et al, 2021 ; Al-Mugheiry et al, 2022 ; Yang et al, 2022 ). Ophthalmoscopy is a common technology used to detect the optic nerve head and neuronal loss (Coote, 1857 ; Quigley and Anderson, 1977 ).…”