Comparison of the long-term outcomes of resident versus attending performed trabeculectomy (original) (raw)
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Long-Term Follow-Up of Initially Successful Trabeculectomy
Ophthalmology, 1997
The purpose was to study the long-term outcomes of primary trabeculectomies that were successful at 1 year. Design: A retrospective study of patients with various types of glaucoma who had trabeculectomies that were successful at 1 year and who had a follow-up of at least 10 years. Participants: There were 40 patients (40 eyes) who had primary trabeculectomies that were successful at 1 year and who had a follow-up range of 10 to 21 years. Intervention: Control of intraocular pressure (lOP) and disease progression was evaluated at 5, 10, and 15 years and at the last obtainable follow-up. Main Outcome Measures: Successful control of lOP was defined as lOP less than 21 mmHg or a reduction of 33% if preoperative lOP was less than 21 mmHg. Successful control of disease progression was defined as stable cup-disc ratios determined by examination, or color photographs or both, as well as stable visual fields. Results: If an eye was considered successful by lOP at 1 year, the probability of successful control of lOP was 82% at 5 years and 67% at 10 and 15 years. If an eye was considered successful by lOP at 1 year, the probability of successful control of disease progression at 5 years was 77%, at 10 years 61 %, and at 15 years 48%. If an eye did not require further glaucoma surgery at 1 year, the probability that it still would not need further surgery at 5 years was 90%, at 10 years 75%, and at 15 years 67%. Forty percent of eyes had cataract extraction by the time of last follow-up examination. Conclusions: Loss of lOP control and progression of glaucomatous damage occurs over time despite initial success at 1 year.
To evaluate the outcome and complications of trabeculectomies performed at two tertiary care hospitals. Material and Methods: A prospective case series of 455 cases of trabeculectomies performed at the Civil Hospital and Lyari General Hospital Karachi from 2000 to 2006. The preoperative and postoperative ocular data of 150 eyes in 120 patients is evaluated. Results: Average follow-up period was 36.2 months with a minimum of 3 months and maximum of 60 months. Only 33% completed follow-up of at least two years so included in the analysis. Success, defined by a postoperative IOP ≤ 21 mm Hg or a decreased postoperative IOP of at least 25% from preoperative pressure if the preoperative IOP was already ≤21 mm Hg, was observed in 121 eyes (82.6 %) at last follow-up without any medication. Notable complications included hyphema of more than 5 days duration in 11(7.3%), Shallow anterior chamber in 6(4.7%), hypotony in 7(4.7%), Choroidal detachment in 2(1.3%), uncontrolled intraocular pressure, requiring further intervention, in 7(4.7%) and endophthalmitis in 1(0.7%). At 2 year follow-up cataract formation was observed in 32(21.7%) cases. Conclusions: Results of this study suggest that the outcomes of trabeculectomies performed in this region have a high success rate, comparable with previous studies in the literature. Rates of complications are overall similar to those found in the published literature. Poor follow-up and non affordability for drugs makes trabeculectomy as a method of first choice.
Outcome of trabeculectomy in hospital Melaka, Malaysia
International journal of ophthalmology, 2012
To study the success and outcome of trabeculectomy in Hospital Melaka. Medical records of all patients who underwent trabeculectomy between January 1, 2007 and October 31, 2010 whom were followed up for at least 6 months postoperatively in Hospital Melaka were retrospectively reviewed. A total number of 117 eyes of 91 patients with the age range between 12 to 84 years underwent primary trabeculectomy (n=20, 17.1%), combine trabeculectomy with cataract surgery (n=90, 76.9%), repeat trabeculectomy (n=5, 4.3%), and combine repeat trabeculectomy with cataract surgery (n=2, 1.7%). The disease spectrum includes primary open-angle glaucoma (POAG) (54 patients, 59.3%), priamry angle-closure glaucoma (PACG) (14 patients, 15.4%), secondary glaucomas (19 patients, 20.9%) and juvenile glaucomas (4 patients, 4.4%). Preoperative mean intraocular pressure (IOP) was (24.69±8.67)mmHg as compared to postoperative mean IOP of (15.81±6.66)mmHg, (15.07±4.72)mmHg and (15.68 ±3.65)mmHg at 6-month, 12-mont...
International journal of research publications, 2023
Trabeculectomy remains the world’s gold standard and the main therapeutic intervention for controlling moderate to advanced glaucoma in Nigeria due to the expensive anti-glaucoma drugs as well as the unavailability of facilities to carry out minimal invasive glaucoma surgery (MIGS). There is still limited knowledge of the outcomes of trabeculectomy surgery in northeastern, Nigeria. To determine the outcomes of trabeculectomy surgery, regarding lowering post-operative Intra Ocular Pressure (IOP), preserved visual acuity (VA) as well as preserved functional vision among glaucoma patients attending Makkah Specialist Eye Hospital Bauchi (MSEHB). A retrospective trabeculectomy surgery data search of operating theatre records was done to collect the outcomes from January 2021 to January 2023. Patients who have undergone trabeculectomy with a minimum follow-up of 6 months were included in the study. The criteria for a good outcome were post-operative IOP of less than 22mmHG or at least 30% reduction from pre-operative levels, and a preserved aided VA. A visiting consultant from the Ophthalmology Department of Federal Teaching Hospital Gombe performed the trabeculectomy surgeries. A total of fifty-two eyes of 50 patients having a postoperative follow-up of six months were included in the study. The mean age at presentation was 54.10(± 13.02) years. On the last day before surgery, the mean Snellen VA was 20/60; 0.37(± 0.36) but became 20/60+3; 0.40(± 0.36) post-operatively, p = 0.01, mean cup-to-disc ratio (CDR) was 0.86(± 0.12) but changed to 0.87(± 0.12) p = 0.79 at six months after surgery. Complete success, qualified success (with postoperative anti-glaucoma eyedrops), and failure of trabeculectomy (even with postoperative anti-glaucoma eyedrops) were 47(90.40%), 4(7.70%), and 1(1.90%), respectively. Based on the IOP, the complete success rate of trabeculectomy was 90.40%. The mean preoperative Snellen VA was improved by about half a line, six months after surgery and there was a significant reduction of IOP from its baseline. These outcomes revolutionize referral/advice of moderate to advanced glaucoma patients for trabeculectomy surgery in our practice as well as assured post-operative reserved vision.
Surgical Complications in the Tube Versus Trabeculectomy Study During the First Year of Follow-up
American Journal of Ophthalmology, 2007
AND THE TUBE VERSUS TRABECULECTOMY STUDY GROUP • PURPOSE: To describe the intraoperative and postoperative complications encountered during the first year of follow-up in the Tube Versus Trabeculectomy (TVT) Study. • DESIGN: Multicenter randomized clinical trial. • METHODS: SETTING: Seventeen clinical centers. STUDY POPULATION: Two hundred twelve patients aged 18 to 85 years who had undergone previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure >18 mm Hg and <40 mm Hg on maximum tolerated medical therapy. INTERVENTIONS: A 350-mm 2 Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). MAIN OUTCOME MEASURES: Surgical complications, reoperation for complications, visual acuity, and cataract progression. • RESULTS: Intraoperative complications occurred in seven patients (7%) in the tube group and 10 patients (10%) in the trabeculectomy group (P ؍ .59). Postoperative complications developed in 36 patients (34%) in the tube group and 60 patients (57%) in the trabeculectomy group during the first year of follow-up (P ؍ .001). Surgical complications were associated with reoperation and/or loss of >2 lines of Snellen visual acuity in 18 patients (17%) in the tube group and 28 patients (27%) in the trabeculectomy group (P ؍ .12). • CONCLUSIONS: There were a large number of surgical complications during the first year of follow-up in the study, but most were self-limited. The incidence of postoperative complications was higher after trabeculec-tomy with MMC than nonvalved tube shunt surgery. Serious complications resulting in reoperation and/or vision loss occurred with similar frequency with both surgical procedures. (Am J Ophthalmol 2007;143: 23-31. © 2007 by Elsevier Inc. All rights reserved.)
Three-Year Follow-up of the Tube Versus Trabeculectomy Study
American Journal of Ophthalmology, 2010
PURPOSE: To report 3-year results of the Tube Versus Trabeculectomy (TVT) Study. • DESIGN: Multicenter randomized clinical trial. • METHODS: SETTING: Seventeen clinical centers. STUDY POPULATION: Patients 18 to 85 years of age who had previous trabeculectomy, cataract extraction with intraocular lens implantation, or both and uncontrolled glaucoma with intraocular pressure (IOP) >18 mm Hg and <40 mm Hg on maximum tolerated medical therapy. INTERVENTIONS: A 350-mm 2 Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC 0.4 mg/ml for 4 minutes). MAIN OUTCOME MEASURES: IOP, visual acuity, use of supplemental medical therapy, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP <5 mm Hg, reoperation for glaucoma, or loss of light perception vision). • RESULTS: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At 3 years, IOP (mean ؎ standard deviation [SD]) was 13.0 ؎ 4.9 mm Hg in the tube group and 13.3 ؎ 6.8 mm Hg in the trabeculectomy group (P ؍ .78). The number of glaucoma medications (mean ؎ SD) was 1.3 ؎ 1.3 in the tube group and 1.0 ؎ 1.5 in the trabeculectomy group (P ؍ .30). The cumulative probability of failure during the first 3 years of follow-up was 15.1% in the tube group and 30.7% in the trabeculectomy group (P ؍ .010; hazards ratio, 2.2; 95% confidence interval, 1.2 to 4.1). Postoperative complications developed in 42 patients (39%) in the tube group and 63 patients (60%) in the trabeculectomy group (P ؍ .004). Surgical complications were associated with reoperation and/or loss of >2 Snellen lines in 24 patients (22%) in the tube group and 28 patients (27%) in the trabeculectomy group (P ؍ .58). • CONCLUSIONS: Tube shunt surgery had a higher success rate compared to trabeculectomy with MMC during the first 3 years of follow-up in the TVT Study. Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 3 years. While the inci-dence of postoperative complications was higher following trabeculectomy with MMC relative to tube shunt surgery, most complications were transient and self-limited. (Am J Ophthalmol 2009;xx:xxx.
Eye, 2022
BACKGROUND/OBJECTIVES: To evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery. SUBJECTS/METHODS: Survey of experienced surgeons who perform trabeculectomy. RESULTS: Forty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/ 47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/ 47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3-4 months (28/47, 59.6%). CONCLUSIONS: Although a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.
The relation of volume and outcome in trabeculectomy
Eye, 2007
Background/aims Higher case volume has been associated with improved outcomes for a number of procedures. This study was designed to investigate whether this relationship existed for trabeculectomy. Methods The study was retrospective and conducted at an ophthalmic unit in the UK. All patients who had unenhanced trabeculectomy between 1996 and 2000 were identified. From their notes, the surgeon who performed the trabeculectomy was ascertained as were any unplanned interventions (eg conjunctival suturing, anterior chamber reformation, repeated attendances) within the first month of surgery. Results Two hundred and eleven trabeculectomies were performed over the study period. Twenty nine had unplanned interventions within the first postoperative month. Analysis of the data indicated that surgeons who performed less than eight operations per year had more complications than those who performed more than 10 per annum. This difference was only significant (v 2 ¼ 4.0, P ¼ 0.045) when the data were aggregated. When separated per year, although not significant, the complication rate of the lower volume group was always higher than the group performing more than 10 per year. Conclusions The results suggest that trabeculectomy can be added to the list of procedures in which larger case volume is associated with fewer early complications and potentially a better outcome. The findings, if replicated, tend to strengthen the argument for subspecialisation in glaucoma with its implications for training and revalidation.