Course of exfoliation and simplex glaucoma after primary trabeculectomy

Abstract

Aim-To study the course of exfoliation and simplex glaucoma with respect to intraocular pressure (IOP) regulation and visual field survival after primary trabeculectomy. Methods-Postoperative IOP regulation and complications were analysed prospectively in 95 patients. Mean follow up was 46 months. Visual field survival was studied by high pass resolution perimetry (HRP) in a subsample of 28 patients. Results-Medical treatment was reinstated in 42% of exfoliation and in 36% of simplex glaucoma. In these patients, mean medicine free survival time, last untreated IOP, and mean IOP at the end of follow up were similar for both glaucoma types. Among patients with controlled postoperative IOP without added medication, mean IOP at the end of follow up was significantly lower in exfoliation glaucoma. Visual field deterioration and the pattern of complications were similar for both glaucoma types. Conclusion-The eVect of trabeculectomy on IOP regulation was good in both types of glaucoma, and somewhat better in exfoliation glaucoma. The magnitude of IOP lowering could not separate patients with continued visual field deterioration from those in whom visual fields remained stable. Visual field preservation was similar for both glaucoma types. (Br J Ophthalmol 1999;83:305-310) Trabeculectomy is the method of choice for surgical treatment of chronic open angle glaucoma. Long term follow up shows that this procedure alone can control intraocular pressure (IOP) for 10 years postoperatively in about 60% of cases.1 With medical treatment, the success rate for IOP control increases to over 90%. Exfoliation glaucoma causes about one half of all cases of chronic open angle glaucoma in Scandinavia.3 Its prognosis on medical treatment is worse in comparison with simplex glaucoma. [4][5][6][7] Argon laser trabeculoplasty (ALT) has better short term eYcacy in exfoliation glaucoma, but the long term results do not diVer between the two glaucoma types.8 9 The poorer response to medical treatment in exfoliation glaucoma explains the larger proportion of this glaucoma type among patients undergoing surgical treatment.Trabeculectomy has been reported to be eVective in exfoliation glaucoma. 10 However, there are only a few studies in which the results of trabeculectomy in exfoliation and simplex glaucoma are compared. Törnqvist and Drolsum 11 and Konstas et al 12 found the response to trabeculectomy better in exfoliation than in simplex glaucoma. The follow up period in the study by Konstas et al 12 was 6 months. In the study by Törnqvist and Drolsum, 11 in which follow up time was <10 years, no analysis was made of preoperative variables and their relation to the outcome of the operation.The aim of the present study was to assess the regulation of IOP and the survival of visual field in exfoliation and simplex glaucoma after primary trabeculectomy. In addition, the following question was to be answered: is there any postoperative IOP that may separate patients at risk for continued visual field deterioration after operation from...

Mitomycin C-augmented deep sclerectomy in primary open-angle glaucoma and exfoliation glaucoma: a three-year prospective study

“…Trabeculectomy has been shown to be effective in the treatment of ExG and some studies showed better results in patients with ExG compared to patients with POAG (To¨rnqvist & Drolsum 1991;Konstas et al 1993;Popovic & Sjo¨strand 1999). Majority of reports concerning DSCI have dealt with POAG eyes with only a few studies on ExG eyes (Mermoud et al 1999a;El Sayyad et al 2000;Shaarawy et al 2001;Ambresin et al 2002;Drolsum 2003Drolsum , 2006.…”

“…Because of the more aggressive nature of ExG, surgical treatments are often required for controlling the IOP in these patients. Previously, trabeculectomy has been reported to be as effective in the treatment of ExG eyes as in POAG eyes (Konstas et al 1993;Popovic & Sjo¨strand 1999). Few trials have compared the efficacy of DS in POAG and ExG.…”

Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

“…48 Following trabeculectomy, patients with PXFG may progress less frequently than those with POAG. 49 Trabeculectomy is more successful with the concomitant use of antimetabolites. When PXFG coexists with advanced lens opacities, combined surgery may be considered.…”

Phacotrabeculectomy With Intraocular Lens (Iol) Implantation in Patients With Coexisting Pseudoexfoliative Glaucoma and Cataract

“…(9) When conventional surgical intervention becomes necessary, filtering surgery is generally advocated. (10) In the new millennium of rapid advancements and modifications in all fields of science and technology, the treatment of coexisting cataract and glaucoma by combined procedure (Cataract extraction, intraocular lens implantation and trabeculectomy) has produced favourable results. Combined procedure not only improves Visual Acuity (VA) and control of Intraocular Pressure (IOP), but also decreases post-operative pressure spikes.…”