Assessing the Status of Filtering Blebs at 5 Year Post- Trabeculectomy (original) (raw)
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BMC Ophthalmology, 2012
Background To determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. Interobserver variability was analyzed. Methods 57 post-trabeculectomy eyes were included. Colour photographs were used to score the filtering bleb in accordance to the Wuerzburg bleb classification score by two different examiners. At the same visit, clinical data such as intraocular pressure, best corrected visual acuity, slit lamp biomicroscopy and medical history were obtained by another examiner. Results After trabeculectomy, 42 out of 57 eyes (73.7%) reached the target pressure (≤21mmHg, and intraocular pressure reduction of at least 20%, without antiglaucoma medication, and without any additional intervention). Fair agreement was found between intraocular pressure and Wuerzburg bleb classification score ≥8 points and ≥7 points (kappa 0.24 and 0.27, respectively). Analyzing the subgroups of the ...
Case Reports in Ophthalmological Medicine, 2021
Introduction To examine the corneal total higher-order aberrations before and after the excision of an overhanging bleb that developed following trabeculectomy. Case Presentation. Two patients who developed overhanging blebs following trabeculectomy with a fornix-based conjunctival flap using mitomycin C (MMC) were assessed. We measured the corneal total higher-order aberrations for a 4 mm pupil diameter using the TOPCON KR-1W wavefront analyzer and the visual acuity before and after bleb excision. The corneal total higher-order aberration (HOA) improved from 0.50 μm to 0.38 μm in case 1 and from 0.59 μm to 0.49 μm in case 2 after bleb excision. The intraocular pressure was identical before and after bleb excision in both cases. No significant changes in the best-corrected visual acuity (BCVA) were noted in case 1; however, BCVA was improved from 20/25 to 20/20 in case 2. Both cases showed improvements in the symptoms of dysesthesia. Conclusion Excision of the overhanging bleb devel...
Trypan blue staining of filtering bleb in eyes with operate trabeculectomy
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH
To report the use of trypan blue staining of the filtering bleb to assess its functional status in eyes undergoing phacoemulsification after trabeculectomy. This retrospective study was conducted at a tertiary eye care centre in North India and studied 33 eyes of 33 patients ( with previously operated trabeculectomy), who underwent phacoemulsification. Trypan blue dye (0.06%) was used to stain the anterior capsule. After completion of phacoemulsification, the staining of the trabeculectomy bleb was noted as diffuse, patchy, minimal or no staining. Of the 33 eyes, 13 had diffuse staining (39.4%, mean IOP = 9.3 ± 2.2 mm Hg), 7 (21.2%, mean IOP= 15.5 ± 1.8 mm Hg) had patchy staining, 4 had minimal staining (12.1%, mean IOP= 17.5 ± 0.5mm Hg) and nine (27.3%, mean IOP= 19.3 ± 1.6 mm Hg) had no staining. These staining patterns were labeled as groups 1 - 4 respectively. Statistical analysis showed that the difference between the IOPs in Group 1 - 2 and between Group 2 - 3 was not signific...
‘Wipe-out’ after subscleral trabeculectomy in advanced glaucoma patients
Delta Journal of Ophthalmology, 2017
The aim of this study was to evaluate the safety of trabeculectomy in advanced glaucoma patients in the Egyptian population, and to detect postoperative wipe-out syndrome in high-risk patients. Patients and methods Thirty-six eyes of 33 patients with advanced glaucoma were included in the study. All patients underwent subscleral trabeculectomy. The patients were followed up for 3 months during which intraocular pressure (IOP), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, fundus examination, and perimetry were done. Results The mean age of the study group was 51.17±2.64 years. The study included 24 males and nine females. The mean preoperative BCVA was 0.36±0.33. the mean IOP was 31±8.75 mmHg and the mean number of medications was 3.08±0.1. In all cases, complete success was achieved except for two cases with qualified success. The BCVA at day 90 showed no change in 21 eyes, visual decline in three eyes and visual gain in 12 eyes. A negative linear correlation was noticed between the percent reduction in IOP and the reduction in BCVA in the first postoperative day (r=−0.239) which was not statistically significant (P=0.162). The color of the neuroretinal rim was not a significant determinant for the final BCVA (P=0.48). Visual field changes showed no statistically significant differences. Conclusion Wipe-out phenomenon is not an ultimate postoperative outcome for filtering surgery in patients with advanced glaucoma. Pale neuroretinal rim and postoperative hypotony are risk factors for postoperative visual deterioration.
Merits of trabeculectomy in advanced and end-stage glaucoma
International journal of health sciences
The aim of the study was to evaluate intraocular pressure (IOP) control, potential benefits, and associated complications in advanced cases of glaucoma (visual acuity of <6/60) after trabeculectomy. Although many studies of trabeculectomy in glaucoma patients have been done, very few in such advanced cases. The study was done on 60 cases of advanced primary open-angle glaucoma (POAG). Trabeculectomy was done and IOP control was assessed. Pre-operative workup included a detailed history, slit lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy using Goldmann 2 mirror lens, and detailed fundus examination with the 78D lens. All the patients were to undergo optical coherence tomography and Humphrey automated perimetry. Out of 60 patients with POAG, 48 were males and 12 were females with a ratio of 4:1. Of all the 60 cases, 36 had a visual acuity of 20/200, 16 had a visual acuity of hand movements, and eight patients had a visual acuity of perception of light. The mean pre...
Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients
Journal of Clinical Medicine
Background: The evaluation of ab interno trabeculectomy, referred to as trabectome®, among Japanese patients is insufficient. Subjects and methods: Japanese patients who underwent trabectome® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. Results: A total of 250 eyes from 197 patients were enrolled. The trabectome® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with th...
One year structural and functional glaucoma progression after trabeculectomy
Scientific Reports
We evaluated the changes in visual field mean deviation (VF MD) and retinal nerve fibre layer (RNFL) thickness in glaucoma patients undergoing trabeculectomy. one hundred patients were examined with VF and spectral-domain optical coherence tomography (OCT) before trabeculectomy and 4 follow-up visits over one year. Linear mixed models were used to investigate factors associated with VF and RNFL. VF improved during the first 3 months of follow-up (2.55 ± 1.06 dB/year) and worsened at later visits (−1.14 ± 0.29 dB/year). RNFL thickness reduced by −4.21 ± 0.25 µm/year from 1st month of follow-up. Eyes with an absence of initial VF improvement (β = 0.64; 0.30-0.98), RNFL thinning (β = 0.15; 0.08-0.23), increasing intraocular pressure (IOP; β = −0.11; −0.18 to −0.03) and severe glaucoma (β = −10.82; −13.61 to −8.02) were associated with VF deterioration. Eyes with VF deterioration (β = 0.19; 0.08-0.29), increasing IOP (β = −0.09; −0.17 to −0.01), and moderate (β = −6.33; −12.17 to −0.49) or severe glaucoma (β = −19.58; −24.63 to −14.52) were associated with RNFL thinning. Changes in RNFL structure and function occur over a 1-year follow-up period after trabeculectomy. Early VF improvement is more likely to occur in patients with mild/moderate glaucoma, whereas those with severe glaucoma show greater decline over one year. Our findings indicate that progression is observable using OCT, even in late-stage glaucoma. Clinically, reduction of intraocular pressure (IOP) remains the only proven treatment for glaucoma 1-3. Landmark glaucoma randomized clinical trials have confirmed the value of lowering IOP in delaying visual field (VF) progression 1-5. Interestingly, recent studies 6-8 have reported that the surgical lowering of IOP in glaucoma can result in the improvement of VF, which lends support to the preliminary data reported by Katz and Spaeth, who demonstrated reversal of structural change and field loss in newly diagnosed patients after commencement of treatment 9,10. Apart from functional changes, others have examined structural changes after trabeculectomy and their potential association with functional changes. The association between structural glaucomatous damage with VF decline after trabeculectomy is complex. The MoreFlow Medical Research Council 5-Fluorouracil (5-FU) study reported that out of 250 eyes, 20 eyes showed structural progression, 35 eyes showed VF progression, and 15 eyes showed both over a five years period 11. In the Collaborative Initial Glaucoma Treatment Study (CIGTS), VF worsening was significantly associated with enlargement of the optic cup, but reversal of cupping was not associated
Short-term outcomes of trabeculectomy surgery in primary open-angle glaucoma
Ibnosina Journal of Medicine and Biomedical Sciences, 2021
Introduction: Trabeculectomy controls the intraocular pressure (IOP) and decreases the progress of open-angle glaucoma; the outcome of such procedure has not been ascertained in Libya. Objective: We report the short-term outcome of trabeculectomy in terms of IOP in primary open-angle glaucoma (POAG). Settings and Design: The medical records of the trabeculectomy patients previously diagnosed with POAG were reviewed retrospectively. Patients and Methods: Case characteristics were extracted including preoperative IOP and the IOP outcome 6 months postoperatively using Goldmann applanation tonometry. Data were presented as frequencies and mean ± standard deviation. Wilcoxon signed-ranks test was used to analyze the changes in the measurement of IOP after trabeculectomy. Results: Fifty-seven cases had trabeculectomy with a mean age of 51.6 ± 12.2 years. There was a statistically difference (P < 0.0001) in the IOP measurement pre and 6 months post trabeculectomy. 39 patients (68.4%) ac...