Trabeculectomy: a retrospective long-term follow-up of 444 cases.

Mills, K B

doi:10.1136/bjo.65.11.790

Cited by 284 publications

(131 citation statements)

References 11 publications

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“…23,24 In our study, the ratio of scleral flap area to sclerostomy area was similar (15 vs 18) as we used a slightly larger diameter sclerostomy punch (1 vs 0.75 mm). This ratio was significantly larger than in the study of Starita et al 12 (15 vs 4).…”

Section: Discussionmentioning

confidence: 61%

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Birchall

Bedggood

Wells

2006

Eye

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Aim To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures Methods Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 Â 4 mm, 16 mm 2 , n ¼ 12) or small scleral flaps (3 Â 2 mm, 6 mm 2 , n ¼ 9) were constructed over 0.76 mm 2 sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. Results Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n ¼ 8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n ¼ 8) flaps (unpaired t-test, P ¼ 0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD ¼ 12.7,.6%) for large and small flap groups, respectively (unpaired ttest, P ¼ 0.2). Conclusions Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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Section: Discussionmentioning

confidence: 61%

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Birchall

Bedggood

Wells

2006

Eye

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“…It is difficult to compare the incidence of cataract in this survey, approximately 20%, with rates reported in the literature, 3,11,13,19,20,26,27,[29][30][31][32][33][34][35] for several reasons. Apart from different definitions of cataract and study designs, studies vary in their length of follow-up.…”

Section: Late Complicationsmentioning

confidence: 85%

“…It is difficult to compare this incidence with those in the literature where the underlying type of glaucoma is often not specified. 12,15,17,26 In both cases the trabeculectomy failed and in one, acuity dropped to count fingers.…”

Section: Early Complicationsmentioning

confidence: 99%

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

Edmunds

Thompson

Salmon

et al. 2002

Eye

276

190

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Results Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n ‫؍‬ 304, 24.6%), shallow anterior chamber (n ‫؍‬ 296, 23.9%), hypotony (n ‫؍‬ 296, 24.3%), wound leak (n ‫؍‬ 216, 17.8%) and choroidal detachment (n ‫؍‬ 175, 14.1%). The most frequent late complications were cataract (n ‫؍‬ 251, 20.2%), visual loss (n ‫؍‬ 230, 18.8%) and encapsulated bleb (n ‫؍‬ 42, 3.4%). The occurrence of most complications was not associated with a consultant's specialist interest, level of activity, type of hospital or region. Encapsulated bleb was reported more frequently in a university hospital setting. ConclusionsThe complication rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. These are similar to previous published studies and highlight in particular, the impact of trabeculectomy on visual acuity in the first year following surgery. This survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level.

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“…This is important because management of one condition may affect the clinical course of the other. Use of glaucoma medications or surgery is known to accelerate cataract formation, [1][2][3] while surgery for cataract may disturb glaucoma control. The aim is to provide the best possible visual acuity and good glaucoma control.…”

Section: Introductionmentioning

confidence: 99%

Outcome of cataract extraction and posterior chamber intraocular lens implantation following glaucoma filtration surgery

Mandal

Chelerkar

Jain

et al. 2005

Eye

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Purpose To evaluate the outcome of cataract extraction (CE) after glaucoma filtering surgery (GFS). Methods A total of 77 eyes (77 patients) who underwent CE with posterior chamber intraocular lens (PCIOL) implantation following GFS by a single surgeon were reviewed. Main outcome measures were preoperative and postoperative intraocular pressures (IOPs), visual acuities, medications, astigmatism, bleb survival, time of surgical failure, complications, and success rate. Results Mean time interval between GFS and CE was 46.8750.9 months (range, 2-348 months). The mean preoperative IOP was 13.974.7 mmHg (range 3-27 mmHg) and mean postoperative IOP at 3 weeks was 13.675.5 mmHg (range, 6-44 mmHg). The mean follow-up was 19.5720.1 months (range, 1.4-73 months; median 10.6 months). Complete success was achieved in 59 eyes (76.7%). The cumulative probability of complete success was 91.373.7, 82.075.6 and 78.176.5% at the end of 6 months, 1, and 2 years, respectively. Visual acuity before CE was p20/50 in all eyes (100%). Visual acuity at last visit was X20/40 in 33 eyes (42.8 %), 20/50-20/80 in 30 eyes (39.0%), p20/100 in 14 eyes (18.2%). Risk factors identified for qualified success included age at CE460 years, interval of p5 months between GFS and CE, use of preoperative glaucoma medications, and postoperative IOP 419 mmHg within 2 weeks. Conclusions IOP and bleb function was maintained after CE with PCIOL implantation following successful GFS with good visual recovery.

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Trabeculectomy: a retrospective long-term follow-up of 444 cases.

Cited by 284 publications

References 11 publications

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

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

Outcome of cataract extraction and posterior chamber intraocular lens implantation following glaucoma filtration surgery

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