Trabeculectomy in the 21st Century

Kirwan, James; Lockwood, Alastair; Shah, Peter; MacLeod, Alex; Broadway, David C; King, Anthony J; McNaught, Andrew; Agrawal, Pavi

doi:10.1016/j.ophtha.2013.07.049

Cited by 267 publications

(264 citation statements)

References 24 publications

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“…The previous study conducted in 1999, which found similar IOP-lowering effect in 30 eyes with PXG and 30 eyes with POAG during a follow-up period of 2 years reported the similar finding with present study [16]. However, the finding from studies published in 2002 and 2013 reported that complete success rates were significantly better in the POAG group than in the PXG group [12,17]. There were no a clear reasons why this discrepancy was happens.…”

Section: Discussionsupporting

confidence: 85%

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

Anbesse¹,

Ayele²,

Gebresellasie³

2017

J Clin Exp Ophthalmol

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Objective: The aim of this study was to assess outcome of Trabeculectomy surgery in terms of preservation of intraocular pressure, visual acuity and optic nerve head defect among patient undergoing trabeculectomy surgery at university of Gondar tertiary eye care and training center. Methods:Hospital based cross sectional study was conducted from January to February 2017. A total of 69 consecutive 'modern' augmented and non-augmented 'safe-technique' trabeculectomies performed over a 2-year period (2012)(2013)(2014) were assessed. Patients' data from the charts were extracted and analyzed by SPSS version 20. Descriptive statistics were done to summarize the data. Paired samples t-test was performed to compare the correspondent preoperative and postoperative IOP, VA and CDR. P-value<0.05% was considered as statistically significant Results: A total of 69 eyes of 63 patients having post-operative follow up of six months were included in the study. The mean age at the presentation was 59.12 ± 12.64 years. On the last day before surgery, mean snellen VA was 0.28 (± 0.23) and it was changed to 0.24 (± 0.20) p=0.38, mean IOP was 31.87 mmHg (± 10.08) and it was reduced to 18.45 mmHg (± 6.12) p=0.001, mean CDR was 0.84 mm (± 0.13) and was changed to 0.85 mm (± 0.12), p= 0.009 at six months after surgery. Complete success and failure of trabeculectomy was 52 (75.4%) and 8 (11.6%), respectively. Conclusion:Based on IOP, the success rate of trabeculectomy was 75.4%. The mean preoperative VA was dropped by one line at six month after surgery and there was significant reduction of IOP from its base line.

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Section: Discussionsupporting

confidence: 85%

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

Anbesse¹,

Ayele²,

Gebresellasie³

2017

J Clin Exp Ophthalmol

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“…), bleb needling and subconjunctival 5-fluorouracil injections are directly related to success, and demand both time and expertise. In the same report, 31 patients (7%) had late-onset hypotony (three of them with visual acuity decreased by >2 Snellen lines), and two patients developed bleb-related endophthalmitis (5) . Incidentally, another recent paper reported that visual loss after surgery, the "wipe-out" phenomenon, is rare, even in patients with advanced glaucomatous visual field loss and split fixation (6) .…”

mentioning

confidence: 77%

“…Moreover, a multicenter analysis showed that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required. These authors showed an intraocular pressure (IOP) equal or less than 18 mmHg in 86% of the patients after a two-year follow-up period, when included hypotensive medication use (5) . They also reported antifibrotics use in 93% of the cases, what corroborated the current practice pattern among glaucoma specialists.…”

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confidence: 99%

Open-angle glaucoma surgery: the current standing

Tavares¹

2014

Arquivos Brasileiros De Oftalmologia

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Glaucoma is an optic neuropathy characterized by progressive degeneration of retinal ganglion cells (1) . It is the main cause of irreversible blindness in the world, and affects more than 70 million people worldwide, being 10% bilaterally blind (2) . Glaucoma can remain asymptomatic until it is severe, leading glaucoma filtration surgery to be performed in advanced cases, often by general ophthalmologists, which may be, in part, responsible for the wrong impression of its low success-rates and high incidence of complications. Therefore, glaucoma surgery is feared by patients and even by some ophthalmologists. Nevertheless, recently published studies on glaucoma surgery safety and efficacy have reported a different reality.First, due to recent diagnostic and therapeutic advancements, including improvements in surgery techniques, the 20-year probability of glaucoma-related blindness in at least one eye was reduced to half during the period from 1965 to 2009 (3) . One of these enhancements was the advent of the safe trabeculectomy technique, proposed by Peng Khaw from the Moorfields Eye Hospital (4) . Moreover, a multicenter analysis showed that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required. These authors showed an intraocular pressure (IOP) equal or less than 18 mmHg in 86% of the patients after a two-year follow-up period, when included hypotensive medication use (5) . They also reported antifibrotics use in 93% of the cases, what corroborated the current practice pattern among glaucoma specialists. The use of mitomycin-C (MMC) during trabeculectomy has not only enhanced its IOP-lowering effect, but also made the postoperative period more challenging. Suture manipulation (including massage, laser suture lysis, etc.), bleb needling and subconjunctival 5-fluorouracil injections are directly related to success, and demand both time and expertise. In the same report, 31 patients (7%) had late-onset hypotony (three of them with visual acuity decreased by >2 Snellen lines), and two patients developed bleb-related endophthalmitis (5) . Incidentally, another recent paper reported that visual loss after surgery, the "wipe-out" phenomenon, is rare, even in patients with advanced glaucomatous visual field loss and split fixation (6) . The Ex-Press ® implantation during glaucoma filtration surgery should be considered as a modification in trabeculectomy, and not as an entirely new procedure. A recent meta-analysis of randomized clinical trials comparing both procedures reported similar efficacy in IOP-lowering, medication reduction, vision recovery, qualified operative success-rates, and a greater incidence of most complications, with the exception of hyphema (7) . Controversy over its application in daily practice exists, as its efficacy and safety are similar to trabeculectomy, however it makes the procedure more costly.Non-penetrating surgical procedures, including deep sclerectomy (DS), are more difficult to perform and requi...

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“…A Multicenter Analysis in the UK published in 2013 showed a significant shift in preference away from 5-FU use (30%) to MMC (63%). Furthermore, antimetabolite augmented trabeculectomy was considered the standard surgical procedure in patients without additional risk factors for scarring [16] .…”

Section: Discussionmentioning

confidence: 99%

Three-Year Follow-Up of Trabeculectomy with 5-Fluorouracil

Lindemann

Plange²,

Kuerten³

et al. 2017

Ophthalmic Res

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Purpose: To evaluate the long-term outcome of trabeculectomy with intra- and postoperative 5-fluorouracil (5-FU) application in glaucoma. Methods: Eighty-six patients with glaucoma planned for primary trabeculectomy with 5-FU and a minimum follow-up of 3 years were retrospectively analyzed. Success rates, postsurgical 5-FU injections, needling procedures, and complications were analyzed. Results: Mean intraocular pressure (IOP) decreased from 27.2 ± 6.7 to 13.2 ± 4.2 mm Hg at 1 year and 13.8 ± 3.7 mm Hg at the 3-year follow-up. The complete success rates (no IOP-lowering medication) were 83, 79, 73, and 45% at 1 year for IOP ≤21, ≤18, ≤16, and ≤12 mm Hg, respectively, and 64, 59, 56, and 20% for these criteria at 3 years. The average number of medications decreased from preoperatively 2.9 ± 1.4 to 0.2 ± 0.5 at 1 year and 0.7 ± 1.1 at 3 years. During the first 6 months, subconjunctival 5-FU injections were performed in 49 cases. Eleven patients underwent bleb needling during the first 6 months and 13 patients underwent the procedure between the 6th month and the 3rd year. Malignant glaucoma and bleb-related endophthalmitis occurred in 1 patient each. Conclusions: Trabeculectomy with 5-FU is an efficient surgical procedure for glaucoma treatment when combined with intensified postsurgical care.

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Trabeculectomy in the 21st Century

Cited by 267 publications

References 24 publications

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

Open-angle glaucoma surgery: the current standing

Three-Year Follow-Up of Trabeculectomy with 5-Fluorouracil

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