Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study

International Ophthalmology - To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or...     

Efficacy and safety of ab interno trabeculectomy in juvenile open-angle glaucoma

Objective

To determine the efficacy and safety of ab interno trabeculectomy with Trabectome in juvenile open-angle glaucoma (JOAG) patients.

Prognosis in juvenile glaucoma after trabeculectomy

PURPOSE: To evaluate the efficacy of trabeculectomy in the patients with juvenile glaucoma in the long-term follow-up. MATERIAL AND METHODS: In 22 of 37 patients--41 trabeculectomies with basal iridectomy were performed. The age of children ranged from 6 to 18 years, mean 12.4 years. In one eye of 15-year-old boy we used Mitomycin C during reoperation. The follow-up period ranged from 2 to 14 years, mean 8 years. Patients were divided into 2 groups depending on the follow-up: I group (19 eyes) was observed 2-6 years, mean 5.1 years, II group (18 eyes) 7-14 years, mean 11.1 years. In the I group 57.9% and in the II group 61% of children were myopic. RESULTS: Intraocular pressure lower or equal to 21 mmHg with no glaucoma medication was obtained in 79% of eyes in the I group and 66.7% of eyes in the II group. The difference was not statistically significant. In other eye local application of B-blockers and dorzolamid decreased intraocular pressure to values safe for the optic nerve, what was monitored by visual acuity and laser scanning tomography. CONCLUSION: Prognosis of juvenile glaucoma patients treated with trabeculectomy is satisfactory but the effectiveness of this procedure decreases together with the elongation of the follow-up period.     

Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma

PURPOSE: We compare the intermediate-term outcome of initial trabeculectomy with adjunctive mitomycin C use versus initial trabeculectomy alone for juvenile primary open-angle glaucoma. METHODS: This retrospective consecutive analysis included 44 eyes from 36 patients with juvenile primary-open angle glaucoma, all of whom underwent either initial trabeculectomy with adjunctive mitomycin C use (15 eyes) or initial trabeculectomy alone without mitomycin C use (29 eyes). We compared the success rate and complications between the two groups in a three-year follow-up period following surgery. RESULTS: Three years subsequent to surgery, the cumulative success probability was 73% for the mitomycin C group and 68% for the control group, there being no real difference between the two groups (p = 0.89). A greater incidence of hypotony maculopathy was found amongst the mitomycin C group than was the case for the control group (20 versus 0%, respectively, p = 0.034). A lower intraocular pressure amongst the mitomycin C group was noted as compared with the control group (10.8 +/- 3.0 versus 13.3 +/- 3.8 mm Hg, respectively, p = 0.017) amongst the successfully treated patients. CONCLUSIONS: Despite the lower intraocular pressure level for the successfully treated patients from the trabeculectomy with mitomycin C group, and a greater incidence of resultant hypotony maculopathy for this group as compared with the trabeculectomy alone group, there appeared to be no significant difference in the cumulative success probability for this group as compared with the trabeculectomy alone group. Therefore, we caution against the use of an initial trabeculectomy with mitomycin C for juvenile primary open-angle glaucoma.     

Postoperative results of non-penetrating trabeculectomy for primary open-angle glaucoma

PURPOSE: To estimate the postoperative results of non-penetrating trabeculectomy(NPT), the success rate of postoperative intraocular pressure(IOP) and the clinical factors affecting postoperative IOP were evaluated. SUBJECTS AND METHODS: 32 eyes of 32 primary open-angle glaucoma(POAG) patients who underwent NPT as the first filtering surgery were enrolled in the study. We evaluated postoperative IOP using the Kaplan-Meier method, a proportional hazard model, and multiple logistic analysis. RESULTS: 53.2% of all patients had an IOP of less than 16 mmHg without antiglaucoma medication, and 63.8% had an IOP of less than 16 mmHg with antiglaucoma medication 36 months postoperatively. The performance of Nd:YAG trabeculopuncture(YLT) was indicated as a significant factor affecting postoperative IOP by the proportional hazard model(p = 0.037). 72.2% of patients who did not undergo YLT had an IOP of less than 16 mmHg without antiglaucoma medication, and 36.5% who underwent YLT had a postoperative IOP of less than 16 mmHg. There was significant difference between the both groups(log rank test, p = 0.045). Preoperative IOP with antiglaucoma medication was indicated as a significant factor affecting performance of YLT by multiple logistic analysis. CONCLUSION: These results suggest that NPT may be useful to reduce the use of antiglaucoma medication in patients with POAG whose preoperative IOP is controllable with antiglaucoma medication.     

Longitudinal change in choroidal thickness after trabeculectomy in primary open-angle glaucoma patients

Purpose

To investigate longitudinal changes in intraocular pressure (IOP), axial length (AL), and choroidal thickness (ChT) in primary open-angle glaucoma (POAG) eyes after trabeculectomy and to evaluate the parameters that might influence those changes.

Methods

In this prospective observational study, we recruited 28 patients with POAG (28 eyes) scheduled for trabeculectomy. The average macular ChTs and foveal retinal thicknesses along 6-mm segments centered on the fovea were examined preoperatively and postoperatively (at 1, 3, and 6 months) using swept-source optical coherence tomography. The IOP, AL, and mean deviation (MD) of standard automated perimetry (SAP) were also analyzed as independent variables.

Results

Results from 16 patients were included in the final analysis. A significant increase in ChT with respect to the preoperative value was observed at every postoperative stage (1 month, P < 0.001; 3 months, P < 0.001; 6 months, P = 0.011), whereas the retinal thickness showed no significant change over the study period. The ChT increase and IOP reduction were sustained throughout the 6-month period without further significant changes. Stepwise multivariate analyses showed significant correlations between the percentage decrease in IOP and the percentage increase in ChT at 1 and 6 months postoperatively. The percentage increase in ChT was also significantly correlated with a better MD of the SAP at 1 month (β = 0.01; P = 0.009).

Conclusions

The ChT increase following trabeculectomy was sustained at 1, 3, and 6 months postoperatively. The percentage increase in ChT was significantly correlated with the percentage change in IOP and (more weakly) with better SAP MD values.

     

抗青光眼手术对原发性开角型青光眼血流动力学的影响

目的 探讨原发性开角型青光眼（primary open-angle glaucoma,POAG）眼血流动力学变化,观察抗青光眼手术对眼血流动力学的影响。方法 利用标准化彩色多普勒成像（color Doppler imaging,CDI）技术检测POAG患者16例20眼手术前后的眼球后血流状态。结果 抗青光眼术后视网膜中央动脉和睫状后短动脉血流速度较术前明显提高,血流阻力下降。结论 抗青光眼术后眼血流可得到改善,有益于保护视功能。CDI检测技术应标准化,实现检测结果的可比性。     

Lens fluorophotometry after trabeculectomy in primary open-angle glaucoma.

OBJECTIVE: To evaluate the loss of lens transparency incurred by patients undergoing trabeculectomy. DESIGN: A prospective cohort study. PARTICIPANTS AND CONTROLS: Data corresponding to 33 eyes of 33 consecutive patients with primary open-angle glaucoma (POAG) subjected to trabeculectomy (group 1) were compared with those corresponding to 12 eyes of 12 patients with POAG receiving topical antiglaucomatous treatment (group 2). INTERVENTION: Lens fluorophotometry was performed on the group 1 patients before and 12 months after surgery. In group 2, fluorophotometry was conducted at the onset of the study and at 12 months of follow-up. MAIN OUTCOME MEASURES: Starting and final lens autofluorescence and transmittance values corresponding to each subject group were compared. RESULTS: In group 1, starting and final autofluorescence was 556.3 +/- 184.3 and 691.1 +/- 179.3 Eq ng/ml, and starting and final transmittance was 0.78 +/- 0.11 and 0.67 +/- 0.14, respectively. Respective values for group 2 were 574.3 +/- 94.8 and 595.2 +/- 107.0 Eq ng/ml and 0.72 +/- 0.17 and 0.71 +/- 0.16. The mean change between final and initial autofluorescence was statistically different between groups (134.7 +/- 123.7, group 1, 20.9 +/- 25.1 Eq ng/ml, group 2; P < 0.001). Similarly, a significant difference (P < 0.001) in transmittance change was observed between the surgery and control groups (-0.11 +/- 0.072, group 1; 0.02 +/- 0.008, group 2) CONCLUSIONS: It was demonstrated by lens fluorophotometry that trabeculectomy in POAG leads to a loss in lens transparency.     

非穿透小梁手术并植入凝胶治疗开角型青光眼

目的　探讨非穿透小梁手术、丝裂霉素的应用、透明质酸钠凝胶的植入的临床效果。方法　 2 8例 (4 2眼 )原发性开角型青光眼行非穿透小梁手术并植入凝胶。术后观察眼压、视功能、滤过泡、眼内反应及前房角镜检查 ,随访 6～ 12月。结果　患者术前眼压 15 6～ 45 0mmHg(1mmHg =0 13 3kPa)平均 (2 6 3 0± 8 96)mmHg ;术后眼压 (15 3 6± 3 68)mmHg ,差异有显著意义(t =7 83 3P <0 0 0 1) ,视功能手术前后差异无显著意义 (χ2 =1 85 ,P >0 0 5 ) ,无浅前房、炎症或脉络膜脱离等并发症。前房角镜检查术区小梁网明显变薄。结论　非穿透性小梁手术并植入凝胶是一种较好的手术方法。     

Long-term results of 5-fluorouracil trabeculectomy for primary open-angle glaucoma

The effect of 5-fluorouracil (5-FU) subconjunctival injection on the bleb formation and intraocular pressure (IOP) following trabeculectomy was studied in 27 primary open-angle glaucoma patients (33 eyes) who had never been operated upon (25 eyes) or had undergone single trabeculectomy that failed to reduce IOP (8 eyes). The results were analyzed by means of life table analysis and compared with those of 65 primary open-angle glaucoma eyes that had undergone trabeculectomy without postoperative administration of 5-FU as the first or the second filtering surgery. The surgical techniques and postoperative care were virtually identical between the eyes treated with 5-FU and the eyes that had undergone trabeculectomy without 5-FU. At the end of 28-month follow-up, the success probability was 74.8% without any postoperative antiglaucoma medication, and 100% with antiglaucoma medication. Whereas, the success probability with postoperative antiglaucoma medication was as low as 60.8% for the first, and 51.5% for the second trabeculectomy without 5-FU at the 24-month follow-up. Postoperative, subconjunctival injection of 5-FU appears to improve the prognosis following trabeculectomy in primary open-angle glaucoma patients.     

Incidence of disc hemorrhages in open-angle glaucoma before and after trabeculectomy

PURPOSE: To investigate the effects of reduction of intraocular pressure (IOP) by surgical intervention on the frequency of disc hemorrhages in eyes with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). DESIGN: Retrospective study. METHODS: We studied 99 eyes of 99 patients with POAG and 50 eyes of 50 patients with NTG, who underwent trabeculectomy with adjunctive mitomycin C (MMC) and were followed regularly at 1 to 3-month intervals at the Glaucoma Service of Gifu University Hospital. We applied Kaplan-Meier life-table analysis for the detection of disc hemorrhages before and after trabeculectomy. RESULTS: Trabeculectomy significantly reduced IOP (in POAG: 19.6 +/- 4.4 down to 11.1 +/- 4.2 mm Hg; in NTG: 15.3 +/- 1.5 down to 11.3 +/- 4.5 mm Hg; mean +/- SD). Life-table analysis revealed that the final cumulative probability of detecting a disc hemorrhage after surgery in POAG was 5.5 +/- 2.2% (calculated probability +/- SE) and was significantly lower than that (33.4 +/- 7.8%) before surgery (P < 0.0001, log-rank test). Likewise, the final probability after surgery in NTG was 23.1 +/- 6.3% and was significantly lower than that (42.1 +/- 8.8%) before surgery (P = 0.0063, log-rank test). CONCLUSIONS: IOP reduction via surgical intervention significantly decreases the frequency of disc hemorrhages in open-angle glaucoma patients.     

The long-term results of fistulising trabeculotomy in chronic open-angle glaucoma

Background : Fistulising trabeculotomy has been used for nearly 20 years to combine the minimally invasive surgery of trabeculotomy with production of a subconjunctival fistula.
Methods : The canal of Schlemm was unroofed 2mm on one side of a 3mm half-thickness scleral flap. A trabeculotomy probe was passed about 30° along the canal on the opposite side and rotated into the anterior chamber.
Results : Of 99 eyes of 74 patients, 35 eyes of 25 patients were available for follow-up at 10 or more years. The mean IOP was 14 ± 4 mmHg (range 7 to 23 mmHg) from a preoperative IOP of 29 ± 8 mmHg (17 to 60 mmHg). Results in 44 similar patients undergoing trabeculectomy and 44 undergoing fistulising trabeculotomy were very similar at five-year follow-up.
Conclusion : Fistulising trabeculotomy was effective for lowering intraocular pressure with a low complication rate and a large area of subconjunctival fistulisation.     

Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma

PURPOSE: To assess the efficacy and postoperative complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: Forty-four eyes of 44 patients with medically uncontrolled open-angle glaucoma had DSCI and a matched control group of 44 patients, trabeculectomy. A superficial scleral flap was raised and a deep sclerectomy performed in the scleral bed. Schlemm's canal was opened, and the cornea was dissected to Descemet's membrane. At that stage, aqueous filtered through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed; the scleral flap and conjunctiva were then closed. Examinations were performed before surgery and postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 15, 18, and 24 months. RESULTS: The mean follow-up was 14.4 months +/- 6.3 (SD) (range 3 to 24 months). The mean preoperative intraoperative pressure (IOP) was 26.7 +/- 7.3 mm Hg. The mean postoperative IOP was 6.1 +/- 4.5 mm Hg at 1 day and 11.0 +/- 4.4 mm Hg at 1 week; it remained stable for the next 24 months. The success rate, defined as an IOP lower than 21.0 mm Hg without medication, was 69% in the DSCI group and 57% in the trabeculectomy group at 24 months postoperatively (P = .047). The number of postoperative complications was significantly lower in the DSCI group than in the trabeculectomy group. CONCLUSIONS: The success rate of DSCI may be comparable to that of trabeculectomy, with fewer complications.