Fornix-based trabeculectomy with Wise’s suture technique in Chinese patients

Ng, Philip W C; Yeung, Barry Y M; Yick, Doris W.F.; Yu, Christopher B O; Lam, Dennis S C

doi:10.1016/s0161-6420(00)00460-7

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The reported incidence of postoperative bleb leak after trabeculectomy ranges from 0 to 56%. 1,14 As we increase efforts to achieve better longterm success with filtering surgery, antimetabolites have gained increasing popularity.…”

Section: Introductionmentioning

confidence: 99%

Early bleb leak after trabeculectomy and prognosis for bleb failure

Alwitry

Rotchford

Patel

et al. 2008

Eye

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Aim To determine whether early bleb leak after MMC trabeculectomy affects intermediate intraocular pressure (IOP) outcome. Methods Retrospective case note review. All cases of MMC trabeculectomy with at least 1-year follow-up were included. Cases where a bleb leak occurred within the first month were identified. All cases without an early bleb leak formed the control group. Patient demographics and clinical factors were analysed to determine any factors predisposing to bleb leakage. IOPs were compared for 1 year postoperatively and final follow-up. Results A total of 119 trabeculectomies were included. Of these 27 (22.7%) had an early bleb leak. The remaining 92 cases formed the control group. Mean age of cases was 70.7 years. Mean follow-up time was 19.5 months. Mean time of detection of the bleb leak was 9 days (range 1-21 days). Four cases (14.8%) were managed by primary resuturing. Thirteen cases (48.1%) were managed conservatively with a bandage contact lens. Ten cases (37.0%) resolved with expectant management. There was no statistically significant difference between the two groups with regards to IOP measurement at any time point. Intervention rates were similar with regards to bleb massage, 5-fluorouracil injection, and needling revision. No factors were identified between the two groups that predisposed to bleb leaks occurring. Conclusion Our data suggest that early bleb leak is not a poor prognostic indicator for intermediate bleb survival and IOP control in patients undergoing MMC trabeculectomy. No additional bleb manipulations compared with the control group were required to achieve a satisfactory IOP outcome.

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Section: Introductionmentioning

confidence: 99%

Early bleb leak after trabeculectomy and prognosis for bleb failure

Alwitry

Rotchford

Patel

et al. 2008

Eye

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“…8 In this study, when assessing the trabeculectomy bleb for leak, the clinicians applied pressure to the conjunctiva in order to increase the consistency of results and increase kappa statistics for assessment. As a result the rates of leakage are a maximum.…”

Section: Discussionmentioning

confidence: 99%

“…Although studies of limbus versus fornix based conjunctival flap in trabeculectomy have shown both groups to be equally successful, 2-5 16 there has been concern over the increased rates of early postoperative bleb leak associated with fornix based flaps. [8][9][10][11][12][13][14][15] This has been a reason for advocating the use of limbus based flaps in preference to fornix based flaps in trabeculectomy surgery. However the fornix based flap has the advantage of producing a better bleb morphology: it is more likely than the limbus based flap to give rise to a diffuse bleb with a normal vascular pattern rather than a cystic bleb.…”

Section: Discussionmentioning

confidence: 99%

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Early postoperative trabeculectomy leakage: incidence, time course, severity, and impact on surgical outcome

Henderson

2004

British Journal of Ophthalmology

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Aim: To establish the incidence, time course, and severity of conjunctival wound leakage following trabeculectomy, and also to establish whether early wound leakage adversely affects the ultimate outcome of the surgery. Method: A prospective, observational case series of sequential trabeculectomies performed in a single institution over a 12 month period. Datasets on 286 operations were analysed. A fornix based conjunctival flap was used in 254 cases and a limbus based conjunctival flap in 41 cases. At every postoperative visit trabeculectomies were assessed for four grades of leakage (none; mild; moderate; severe), and for success or failure at the 6 month follow up post surgery. Pressure was applied to the trabeculectomy bleb to record the maximum rates of leakage and improve kappa statistics. Study clinicians were validated with respect to their scoring of leaks before starting the study. Results: 169 of the 286 trabeculectomies (59%) showed leakage at some stage postoperatively. 159 of 245 fornix based flaps (65%) leaked compared with 10 of 41 limbus based flaps (24%). Median time to leak was 3.5 (range 0-408) days. Median duration of leakage was 14 (range 2-457) days. 14 (5%) of trabeculectomies failed completely. A further 40 (14%) were a partial failure. In total, 23 of 117 (20%) without postoperative leaks partially or completely failed compared with 31 of 169 (18%) with leaks. Cross tabulation of partial and complete failure by leak shows no evidence of an adverse effect of leaking on the outcome (x 2 = 1.81, p = 0.4). Conclusions: There is no evidence to support the hypothesis that early postoperative leakage of fornix based conjunctival flaps affects the outcome of trabeculectomy.

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“…Various techniques have been used to minimize this complication 9,10 . Wise's suture technique, which has been used in Chinese patients, 11 is both safe and effective but it is time‐consuming. Therefore, newer suture techniques have been explored.…”

Section: Introductionmentioning

confidence: 99%