IJCRR - Vol 07 Issue 17, September, 2015
OUTCOME OF CONVENTIONAL TRABECULECTOMY WITH OR WITHOUT CATARACT SURGERY
Author: Usha B.R., M. S. Usha, M. Brinda Prasad
Purpose: To study the outcome of conventional trabeculectomy with or without cataract surgery in different types of glaucoma in low risk cases.
Materials and Methods: 50 consecutive eyes, each undergoing conventional trabeculectomy and, 50 eyes combined with cataract surgery are included in this prospective study; each patient had a minimum period of follow-up for six months. Preoperative details of medications, visual acuity, slit lamp evaluation, applanation tonometry, cup to disc ratio and visual fields were compared with similar parameters postoperatively. “Complete success” was defined in this study as intraocular pressure (IOP) <21mmHg or 30% reduction from the preoperative IOP. Latest IOP recorded in each eye has been considered for this study.
Results: Postoperative mean IOP in the trab group was 13.08 + 3.52 mm Hg and in combined group it was 13.70 + 3.31 mm Hg during 100% visits, with follow ups ranging from six months to > 5 years. There was no significant difference in IOP reduction between trabeculectomy and combined groups. 87% of long-term “Complete Success” rate in both the groups and 76% visual outcome of > 6/18 in the combined group may be attributed to minimum rate of complications.
Conclusion: Conventional trabeculectomy without using antimetabolites is successful even in the present day glaucoma management in low risk glaucoma cases, when performed with technical precision aided by vigilant postoperative care. It is equally effective and convenient when combined with cataract surgery in relevant cases.
Keywords: Glaucoma, Conventional trabeculectomy, Combined surgery, Complete success, Intraocular pressure, Antimetabolites
Usha B.R., M. S. Usha, M. Brinda Prasad. OUTCOME OF CONVENTIONAL TRABECULECTOMY WITH OR WITHOUT CATARACT SURGERY International Journal of Current Research and Review. Vol 07 Issue 17, September, 20-26
1. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968. 66:673-9.
2. Watson, P.G. and Grierson. The Place of Trabeculectomy in the Treatment of Glaucoma. Ophthalmology, 88, 175-196.
3. D’Ermo F, Bonomi L, Doro D. A critical analysis of the longterm results of trabeculectomy. Am J Ophthalmol 1979. Nov;88(5):829-835
4. K B Mills Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol. 1981 Nov; 65(11): 790–795.
5. Nouri-Mahdavi K, Brigatti L, Weitzman M, Cprioli J. Outcomes of trabeculectomy for primary open-angle glaucoma. Ophthalmology. 1995 Dec; 102(12):1760-9. 6. Chen H, Ge J, LiuX, LuF. The clinical analysis of 260 combined surgery of glaucoma and cataract. Yan Ke Xue Bao (Pubmed Article in Chinese - English) 2000 Jun; 16 (2): 102 - 5.
7. Editor,: “Glaucoma in the developing world” BMJ 2006 (4 Nov.); 33 : 932
8. Kumari R., Badhu BP, Das H. “Effectiveness of combination of permanent and releasable scleral flap sutures in trabeculectomy: A randomized clinical trial”, Kathmandu University Medical Journal 2006 Vol.4; No.4, Issue 16: 419 - 425.
9. Douglas R. Anderson, Vincent Michael Patella in: Automated Static Perimetery: Chapter 7: Interpretation of a single field, 2nd ed. Mosby; 1999 page 164.
10. Klein BEK, Klein R, Sponsel WE: Prevalence of glaucoma. Ophthalmology, 1992; 99: 1499 - 504.
11. Scott Fraser, Richard Wormald: Chapter 210, Epidemiology of Glaucoma, in: Ophthalmology, Vol. 2 by Myron Yanoff, Jay S. Duker, 2nd ed. MOSBY: 2004. pp 1413 - 14.
12. The AGIS investigators. The advanced glaucoma intervention study (AGIS): 7 “The relationship between control of intraocular pressure and visual field deterioration”, Am J Ophthalmol 2000 Oct; 130(4): 429 - 40.
13. Ehrnrooth P, Lento, Puska P, Laatikainenl. Long term outcome of trabeculectomy in terms of IOP. Acta Ophthalmol Scand 2002; 80: 267 - 71.
14. Andreas Wedrich, Rupert Menapace, Ursula Redax, Panos Papapanos and Michael Amon, Cataract surgery and trabeculectomy- technique and results. International Ophthalmology 1992; Volume 16, Numbers 4-5, 409-14.
15. Y.A. Mutsch and F.Grehn. Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified post operative care (IPC) ; Graefe’s Archive for clinical and experimental ophthalmology 2000 ;Vol. 238, number 11: 884 - 891.
16. ME Gyasi, WMK Amoaku, OA Debrah, EA Awini and P Abugri. Outcome of Trabeculectomies without Adjunctive Antimetabolites. Ghana Med J. 2006 June; 40 (2): 39-44.
17. R. Rand Allingham, Shields’ Text Book of Glaucoma, chapter 40: Filtering surgery, fifth ed. Lippincott Williams and Wilkins; 2005. pp 583 - 594.
18. Sandra J. Sofinski, Pranav Amin, and R.Rand Allingham, Chapter 226: Glaucoma filtration surgery. In Principles and Practice of Ophthalmology, Albert and Jakobiec, Azar, Gragoudas; volume 4, 2nd ed. W.B. Saunder company; 2000. pp 2959-60
19. B.Edmunds, JR Thompson, JF Salmon: Clinical study: The national survey of Trabeculectomy III-Early and late complications; Eye 2002; 16: 297 - 303.
20. Prasad VN, Narain M, Bist HK, Khan MM. Trepano - trabeculectomy (a combined operation for glaucoma); Indian J Ophthalmol 1984; 32: 73 -75.
21. Konstas AG, Jay JL, Modification of trabeculectomy to avoid postoperative hyphaema: “The guarded anterior fistula” operation; Br J Ophthalmol 1992; 76: 353.
22. Robert L Stamper, Marc F. Lieberman, Michael V. Drake In: Becker - Shaffer’s Diagnosis and therapy of the Glaucomas, Part VIII, chapter 36, 7th ed., Mosby ; 1999: pp 591 - 92.
23. Popovic V, Sjostrand J. Long term outcome following trabeculectomy: Retrospective analysis of intraocular pressure regulation and cataract formation. Acta Ophthalmol (Copenh) June 1991; 69: 299-304
24. Akafo SK, Goulstine DB, Rosenthal AR. Long-term, post trabeculectomy intraocular pressures. Acta Ophthalmol (Copenh) 1992; 70: 312.
25. Vesti E. Filtring blebs: Follow up of trabeculectomy. Ophthalmic surgery 1993; 24:249-255.
26. Pia Ehrnrooth: “Long term outcome of trabeculectomy in primary open angle Glaucoma and Exfoliation Glaucoma”: Department of Ophthal, university of Helsinki, Finland; 2005:17 -32. (http:// ethesis.helsinki.fi / julkaisut / laa / kli in vk /ehrnrooth)
27. Ghazala tabassum, Imran Ghayoor et al. The effectiveness of conventional trabeculectomy in controlling intra ocular pressure in our population. Pak J Ophthalmol 2013 Vol.29 No.1: 26-30.
28. Per Julius Nielsen, MD: Combined Small-Incision Cataract Surgery and Trabeculectomy- A prospective study with 1 year of Follow-up; Ophthalmic surg Lasers 1997; volume 28(1): 21-29.
29. Urban V, Kamman MT, Sturmer JP, Glaucoma and Cataract: Combined operation or, trabeculectomy first and cataract extraction later? Klin Monatsbl Augenheilkd (pubmed article in German – English) 2000 Feb; 216 (2): 105 –11.
30. Khurana AK et al. Combined SICS and trabeculectomy; Nepal J Ophthalmol 2011; 3(5): 13 – 18.
31. Edward J Rockwood. Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries. Am J Ophthalmol 2000 Dec; 130 (6): 704 –11.