Conditions for balance between lower normal pressure control and hypotony in mitomycin trabeculectomy

Hara, Takeshi; Araie, Makoto; Shirato, Shiroaki; Yamamoto, Seiichiro

doi:10.1007/s004170050100

Cited by 24 publications

(21 citation statements)

References 41 publications

(49 reference statements)

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“…15 A balance must be sought between the risks of inducing hypotony and ensuing complications and the attainment of a safe IOP facilitating long-term successful surgery. 10 Analysis of factors contributing to postoperative complication is limited in this study because of a relatively low incidence. It is also important to emphasize that this study did not assess bleb morphology in the early postoperative period.…”

Section: Resultsmentioning

confidence: 97%

“…[10][11][12]14,16 A retrospective analyses of 92 glaucoma patients with antimetabolite-augmented filtering surgery suggested that 16 mm Hg on day 1 predicted long-term success (r21 mm Hg without medication) and failure with an accuracy of 88.8 and 55.5%, respectively. 12 Another retrospective assessment involved a 2-year follow-up on 203 eyes undergoing unaugmented trabeculectomy.…”

Section: Resultsmentioning

confidence: 99%

“…[6][7][8][9] Existing evidences suggest an association between early postoperative IOP and long-term effectiveness of trabeculectomy. [10][11][12][13] Long-term success might be predicted by early postoperative IOP with sensitivity from 89 to 93%. 11,12 Accordingly, it has been suggested that a higher IOP after the first postoperative week may require early intervention to ensure success.…”

Section: Introductionmentioning

confidence: 99%

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Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Rong

Feng

Wang

et al. 2013

Eye

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Purpose To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome. Methods A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (o10 mm Hg), B (Z10 and o15 mm Hg), C (Z15 and o20 mm Hg), and D (Z20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome. Results The mean age was 62.5 ± 7.9 years and 41.21% (n ¼ 68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P ¼ 0.047, P ¼ 0.033, P ¼ 0.008, and Po0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP o15 mm Hg (Fisher's exact P ¼ 0.001) and o20 mm Hg (P ¼ 0.039) without medication.Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOPo15 mm Hg without medication and failure after surgery, respectively. Conclusions The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Rong

Feng

Wang

et al. 2013

Eye

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“…17 This is especially beneficial in Mitomycin C enhanced trabeculectomy where low IOP in the first two postoperative weeks is a risk factor for more prolonged hypotony. 18 Trabeculectomy using a small scleral flap appears to provide medium to long-term IOP control comparable to large flap techniques 12,15,19 and may offer potential advantages: reduced surgical tissue trauma, a larger area of undisturbed sclera and conjunctiva should repeat surgery be required, and reduced astigmatism induction. 20 Potential disadvantages include possible decreased control over aqueous flow, technical challenges including difficulty in dissecting a large treatment area for antimetabolite application and difficulty in controlling subconjunctival bleeding if the conjunctival incision is small.…”

Section: Introductionmentioning

confidence: 99%

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

Birchall

Bedggood

Wells

2006

Eye

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Aim To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures Methods Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 Â 4 mm, 16 mm 2 , n ¼ 12) or small scleral flaps (3 Â 2 mm, 6 mm 2 , n ¼ 9) were constructed over 0.76 mm 2 sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. Results Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n ¼ 8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n ¼ 8) flaps (unpaired t-test, P ¼ 0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD ¼ 12.7,.6%) for large and small flap groups, respectively (unpaired ttest, P ¼ 0.2). Conclusions Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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“…We considered therefore that a cutoff IOP was more suitable for evaluating postoperative IOP after trabeculectomy. In addition, we considered the relationship between long-term IOP reduction and the cutoff IOP with reference to a study by Hara et al 21 Most surgical treatments for glaucoma, including MMC trabeculectomy, bypass the canal of Schlemm and drain aqueous humor into the subconjunctival space. 21 Long-term scarring of the conjunctiva and scleral flap reduces the effectiveness of these procedures over time and results in increasing IOP.…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Mitomycin C Trabeculectomy and Laser Suture Lysis Depends on Postoperative Management

et al. 2006

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Conditions for balance between lower normal pressure control and hypotony in mitomycin trabeculectomy

Abstract: IOP of 8 mm Hg 9-14 days after surgery may be advisable in patients with preoperative multiple medications in whom IOP control to lower normal level is attempted with mitomycin C trabeculectomy. Knowledge of this may be helpful in deciding when laser lysis of sutures is indicated.

Cited by 24 publications

References 41 publications

Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

The Outcome of Mitomycin C Trabeculectomy and Laser Suture Lysis Depends on Postoperative Management

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