Outcomes and Bleb-Related Complications of Trabeculectomy

Jampel, Henry D.; Solus, Jason F.; Tracey, Patricia A.; Gilbert, Donna; Loyd, Tara L.; Jefferys, Joan L.; Quigley, Harry A.

doi:10.1016/j.ophtha.2011.09.049

Cited by 147 publications

(120 citation statements)

References 42 publications

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“…In our trabeculectomy group, complications were mostly hypotony-associated as it has been reported in retrospective studies (Gedde et al 2012;Jampel et al 2012). Severe bleb-related infections, blebitis and endophthalmitis are rare but serious visionthreatening complications after trabeculectomy (Yamamoto et al 2013).…”

Section: Discussionsupporting

confidence: 60%

“…Non-penetrating, bleb-free glaucoma procedures intend to efficaciously lower IOP without the risk of severe postoperative complications and the need for an intensive postoperative care as it becomes necessary after filtration surgery (Godfrey et al 2009;Francis et al 2011;Grieshaber 2012;Jampel et al 2012;Bettin & Di Matteo 2013;Wallin et al 2013;Yamamoto et al 2013). Canaloplasty is a relatively novel surgical method which aims at restoring the natural pathway of aqueous humour outflow via Schlemm's canal using circumferential viscodilation and a tension suture to permanently distend the trabecular meshwork without inducing a filtering bleb (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012;Klink et al 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Trabeculectomy achieves an excellent IOP reduction, remains the most frequently performed glaucoma surgery and is still considered as the gold standard in the surgical treatment of patients with glaucoma since its first introduction by Cairns (1968). Severe adverse events and the need for an intensive postoperative treatment regimen have encouraged glaucoma surgeons to develop less invasive nonpenetrating procedures avoiding filtering blebs (Godfrey et al 2009;Francis et al 2011;Grieshaber 2012;Jampel et al 2012;Bettin & Di Matteo 2013;Wallin et al 2013;Yamamoto et al 2013). Canaloplasty is a non-filtering, bleb-free method combining viscocanalostomy with the placement of a 360°i ntracanalicular tension suture within Schlemm's canal, thus allowing aqueous humour outflow through the natural pathway (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

Matlach

Dhillon

Hain

et al. 2015

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare the outcomes of canaloplasty and trabeculectomy in openangle glaucoma. Methods: This prospective, randomized clinical trial included 62 patients who randomly received trabeculectomy (n = 32) or canaloplasty (n = 30) and were followed up prospectively for 2 years. Primary endpoint was complete (without medication) and qualified success (with or without medication) defined as an intraocular pressure (IOP) of ≤18 mmHg (definition 1) or IOP ≤21 mmHg and ≥20% IOP reduction (definition 2), IOP ≥5 mmHg, no vision loss and no further glaucoma surgery. Secondary endpoints were the absolute IOP reduction, visual acuity, medication, complications and second surgeries. Results: Surgical treatment significantly reduced IOP in both groups (p < 0.001). Complete success was achieved in 74.2% and 39.1% (definition 1, p = 0.01), and 67.7% and 39.1% (definition 2, p = 0.04) after 2 years in the trabeculectomy and canaloplasty group, respectively. Mean absolute IOP reduction was 10.8 AE 6.9 mmHg in the trabeculectomy and 9.3 AE 5.7 mmHg in the canaloplasty group after 2 years (p = 0.47). Mean IOP was 11.5 AE 3.4 mmHg in the trabeculectomy and 14.4 AE 4.2 mmHg in the canaloplasty group after 2 years. Following trabeculectomy, complications were more frequent including hypotony (37.5%), choroidal detachment (12.5%) and elevated IOP (25.0%). Conclusions: Trabeculectomy is associated with a stronger IOP reduction and less need for medication at the cost of a higher rate of complications. If target pressure is attainable by moderate IOP reduction, canaloplasty may be considered for its relative ease of postoperative care and lack of complications.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

Matlach

Dhillon

Hain

et al. 2015

Acta Ophthalmologica

View full text Add to dashboard Cite

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“…In our study, no bleb-related infection was observed during the study period. This result was comparable with the previously reported incidence of bleb-related infection of 0.5% -1.0% per year [3] [21].…”

Section: Discussionsupporting

confidence: 92%

Efficacy and Safety of Low Target Pressure Trabeculectomy: 2-Year Clinical Results

Ha¹

2018

OJOph

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Purpose: To compare the success and complication rates of low target pressure trabeculectomy (LTT) and conventional trabeculectomy (CT). Methods: A retrospective study was conducted with consecutive patients undergoing trabeculectomy. Twelve eyes of 12 patients underwent LTT, and 17 eyes of 17 patients underwent CT. Surgical success was defined as meeting each target intraocular pressure (IOP) without additional medication or further glaucoma surgery. A Kaplan-Meier survival analysis was used to estimate survival rate. Incidences of surgical complications were also assessed. Results: The median postoperative IOP 2 years after surgery were 10.0 mmHg (interquartile range [IQR] 8.5 -12.0 mmHg) in the LTT group and 16.0 mmHg (IQR, 14.0 -18.5 mmHg) in the CT group (P = 0.000). Estimated survival rates for patients who underwent the two types of trabeculectomy were significantly different with all IOP criteria of 10, 12 and 14 mmHg (P < 0.01 for all), except IOP ≤ 18 mmHg. Vision-threatening complications were not found in either group during the observation period. Late-onset bleb leaks occurred in only two eyes in the LTT group but were well treated with autologous blood injection and amniotic membrane transplantation. Conclusion: LTT provided more chances to maintain low postoperative IOP and had no more vision-threatening complication than those of CT.

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“…3,[5][6][7] Combined surgery is effective in lowering IOP but carries risk of postoperative complications and failure. [8][9][10] The incidence of complications can be reduced by adopting the new surgical technique of safe surgery system trabeculectomy developed by Peng Khaw at Moorfields Eye Hospital. 11,12 It is an evidencebased, step-by-step approach to trabeculectomy surgery that preserves vision in patients with glaucoma by minimizing complications while maintaining a desired IOP.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction

Raje¹,

Rathi

Agashe

et al. 2014

Eye

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Purpose To determine the efficacy of safe surgery system trabeculectomy combined with manual small incision cataract surgery/ phacoemulsification in primary glaucoma coexistent with cataract. Methods This is a retrospective analysis of 105 cases who underwent single-site combined surgery between January 2008 and December 2009. Safe surgery system trabeculectomy with diffuse and posterior application of mitomycin C was performed in all cases. Cataract extraction was done either by Manual Small Incision Cataract Surgery (MSICS) or phacoemulsification. Main outcome measures were success rate of trabeculectomy, as determined by four different IOP goals and incidence of postoperative complications. Analysis was performed using R-2.15, and the significance was tested at 5% level. Results The minimum follow-up period was 12 months. The overall success rates (with or without medication) when safe surgery system trabeculectomy was combined with MSICS were 91, 70, and 51% for IOP r18, r15, and r12 mm Hg, respectively, and target IOP was achieved in 72% cases. The mean IOP reduction was 43.8% with MSICS and 42.08% with phacoemulsification. The surgical outcome was not significantly different for both techniques. Postoperative complications were infrequent and comparable. Conclusion The Safe Surgery System Trabeculectomy combined with cataract surgery offers excellent IOP control with minimal postoperative complications. It offers an effective and improved solution for primary glaucoma coexistent with cataract found in developing countries.

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Outcomes and Bleb-Related Complications of Trabeculectomy

Cited by 147 publications

References 42 publications

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

Efficacy and Safety of Low Target Pressure Trabeculectomy: 2-Year Clinical Results

Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction

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