Trabeculectomy in Nigerian patients with open-angle glaucoma.

Thommy, C P; Bhar, I S

doi:10.1136/bjo.63.9.636

Cited by 29 publications

(15 citation statements)

References 22 publications

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“…4 Also, trabeculectomy has been reported to be more beneficial in Africans in term of IOP lowering effect and slowing down of field loss. [5][6][7] The goal of the surgery is to establish a permanent flow of aqueous from the anterior chamber to the subconjuctival space thereby lowering the IOP.…”

Section: Introductionmentioning

confidence: 99%

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

Ashaye

Komolafe

2007

Eye

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Objective To describe the post-operative complications reported in patients who had trabeculectomy with and without antimetabolite in UCH, Ibadan between 1999 and 2003 and the success rate achieved in term of the post-operative intraocular pressure (IOP). Methods A retrospective study of the records of glaucoma patients who had trabeculectomy between 1999 and 2003 and had follow-up in UCH Ibadan eye clinic for a minimum of 1 year was carried out. Results Seventy-six out of 171 eyes that had trabeculectomy during the period were reviewed. Mean age of patients was 49.4 years. The mean preoperative IOP was 31.8 mm Hg. Success rate of 79.4% was achieved in term of IOP control at a year of follow-up. The most frequent early post-operative complication was shallow AC (13 eyes; 17.1%) while late complication was elevated IOP (21 eyes; 27.6%). Others were encapsulated bleb 7.9% and hyphema 3.9%. There was no significant difference in the complication rate in those who had intraoperative antimetabolite (5-fluorouracil) when compared with those operated without antimetabolite. Conclusion Guarded filtration surgery is effective in controlling IOP. Most of the complications noted were transient and not visually threatening.

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Section: Introductionmentioning

confidence: 99%

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

Ashaye

Komolafe

2007

Eye

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“…Moreover, reports of surgical outcomes for glaucoma from this region are few and limited by poor follow-up and inadequate statistical analyses. [7][8][9][10][11][12][13] We have previously reported that the probability of achieving an IOP less than 22 and 16 mmHg 5 years after primary nonaugmented trabeculectomy in Nigeria was 71 and 46%, respectively. 7 A randomised prospective trial in Ghana, West Africa demonstrated that intraoperative 5-fluorouracil (5-FU) application during trabeculectomy results in lower intraocular pressures (IOP) in the short term.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative 5-fluorouracil application during primary trabeculectomy in Nigeria: a comparative study

Mielke

Dawda

Anand

2003

Eye

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Purpose To investigate the effect on intraocular pressure (IOP) of intraoperative 5-fluorouracil (5-FU) application during primary trabeculectomy in a West African population. Methods Retrospective case note search of operating theatre records for primary trabeculectomy between 1996 and 2000 in an eye hospital in Lagos, Nigeria. For statistical analysis, patients were divided into group that received intraoperative 5-FU (50 mg/ml for 5 min) and a control group that received no intraoperative antimetabolites. Patients with a follow-up of less than 6 months were excluded. For life-table analysis, only one eye from each patient was included to maintain independent analysis. Results A total of 154 eyes of 101 patients were included in the study. Average follow-up was 17 7 2.18 (95% confidence interval) months. No significant difference was found between the groups for age, sex, preoperative medication, and follow-ups. Comparison of survival curves by the log-rank test showed that the probability of maintaining an IOP of 20 mm Hg or less at 18 months was 76% in the 5-FU group and 79% in the controls (P ¼ 0.55). However, the probability of maintaining an IOP 14 mmHg or less was significantly greater in the 5-FU group (64%) than in the controls (39%, P ¼ 0 .018). Visual acuity loss of more than two Snellen-chart lines was observed in six eyes (7.9%) of the 5-FU group and in four eyes (5.1%) of the control group and this difference was not significant (P ¼ 0.49, Fisher exact test). Complication rates were similar in each group. Conclusions In this population, intraoperative 5-FU application during trabeculectomy appears to improve probability of maintaining an intraocular pressure of 14 mmHg or less with no additional deleterious effects on the eye.

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“…These have included alteration of the size of the scleral flap and of the corneal block,3 alteration of the thickness of the scleral fl ap,4 trabeculectomy with fistula formation,S the omission of scleral flap sutures and posterior lip cautery. 6 The orig inal procedure made use of a limbal-based conjunctival flap,1 but others have advocated the use of a fornix-based conjunctival flapY-1O The theoretical advantages of the fornix-based conjunctival flap include: improved expo sure and access; reduced risk of conjunctival button-hole formation; reduced incidence of thin-walled blebs; and location of the bleb more posteriorly, away from the cor nea. However, no study has shown a significantly improved long-term outcome with either flap.…”

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Is high initial aqueous outflow of benefit in trabeculectomy?

Batterbury

Wishart

1993

Eye

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Liverpool SUMMARYA modification of the trabeculectomy technique was designed in an attempt to increase the outflow of aqueous into the subconjunctival space in the early post-operative period . This 'high flow' method was compared with a control group of eyes undergoing a standard trabeculec tomy. Fifty-three eyes of 44 patients were recruited to this study. Follow-up was for a minimum of 12 months (mean 20 months). The high flow method resulted in lower intra ocular pressures (lOP) on days 1 and 2 and shallower anterior chambers without increased incidence of con junctival wound leak, suggesting that high outflow was indeed achieved . However, long-term control of lOP was not better than that achieved by the conventional tech nique. lOP control (lOP <21 mmHg) was achieved in 64.2% of eyes (34 eyes) without additional topical medi cation . lOP control with topical medication was satisfac tory in the remaining 19 eyes, and no patient required further drainage surgery. Further analysis of the data showed that the most important factor determining suc cess or failure of trabeculectomy in controlling lOP was the duration and number of prior topical medications .The success rate for trabeculectomy was significantly higher in those eyes with a shorter duration and quantity of prior topical therapy.Since the introduction of the trabeculectomy by Cairns I and Watson2 there have been several attempts to modify the technique to improve on the outcome. These have included alteration of the size of the scleral flap and of the corneal block,3 alteration of the thickness of the scleral fl ap,4 trabeculectomy with fistula formation,S the omission of scleral flap sutures and posterior lip cautery.6 The orig inal procedure made use of a limbal-based conjunctival flap,1 but others have advocated the use of a fornix-based conjunctival flapY-1O The theoretical advantages of the fornix-based conjunctival flap include: improved expo sure and access; reduced risk of conjunctival button-hole formation; reduced incidence of thin-walled blebs; and location of the bleb more posteriorly, away from the cor nea. However, no study has shown a significantly improved long-term outcome with either flap.Correspondence to: P. K. Wishart, FCOphth, St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot St., Liverpool L7 8XP, UK. Eye (1993) 7, 109-112With a trabeculectomy with a fornix-based conjunctival flap, there is routinely escape of aqueous. at the cut edge of the conjunctiva, though in most cases this resolves sponta- II• neously. Because of this leak, most surgeons would be reluctant to suture loosely a scleral flap under a fornix based conjunctival flap, in case gross leakage occurred, leading to prolonged hypotony and anterior chamber shal lowing. Thus most surgeons prefer to reduce this risk by tightly suturing the scleral flap to limit egress of aqueous into the subconjunctival space. Savage et al.12 advocated this technique and manipulated post-operative aqueous outflow by selective laser lysis of scleral flap sutures.The aim ...

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Trabeculectomy in Nigerian patients with open-angle glaucoma.

Cited by 29 publications

References 22 publications

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

Intraoperative 5-fluorouracil application during primary trabeculectomy in Nigeria: a comparative study

Is high initial aqueous outflow of benefit in trabeculectomy?

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