Outcomes of primary trabeculectomy with mitomycin-C for primary angle closure glaucoma among supervised trainees in a tertiary eye center in Manila

Leon, John Mark de; Pionela, Crissa Marie G

doi:10.1007/s10792-021-01705-4

Cited by 4 publications

(8 citation statements)

References 13 publications

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“…In this retrospective cohort study examining 435 eyes in 379 patients, we could show that TE was completely successful in an estimated 75% of cases after 5 years. Although some studies have reported similarly high success rates,15 others have reported considerably lower survival rates without the use of IOP-lowering medication, for example, approximately 35% after 5 years16 or 45.8% after 2 years 24. In the latter study, surgery was performed by trainees, which may have influenced the success rates, as higher complication rates among less experienced surgeons have been reported 25.…”

Section: Discussionmentioning

confidence: 98%

“…Although some studies have reported similarly high success rates, 15 others have reported considerably lower survival rates without the use of IOP-lowering medication, for example, approximately 35% after 5 years 16 or 45.8% Open access after 2 years. 24 In the latter study, surgery was performed by trainees, which may have influenced the success rates, as higher complication rates among less experienced surgeons have been reported. 25 In comparison, all trabeculectomies assessed in this cohort were performed by glaucoma specialists in the field.…”

Section: Discussionmentioning

confidence: 99%

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Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

et al. 2023

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ObjectiveTo evaluate the long-term outcomes of trabeculectomy (TE) surgery in a large cohort with a minimum follow-up of 3 years.DesignRetrospective cohort study.SettingUniversity Eye Hospital, Germany.ParticipantsThree hundred and seventy-nine patients with open-angle glaucoma underwent TE with mitomycin C (MMC) between January 2013 and February 2017 with a minimal follow-up of 3 years. Eligible patients were identified via an electronic surgical case register.InterventionsAll patients had undergone TE with MMC following a set surgical protocol. To assess the influence of cataract surgery following TE, eyes which underwent cataract surgery at least 6 months after TE were matched 1:3 by sex and age to eyes who did not undergo cataract surgery during the follow-up period.Main outcome measuresPrimary outcome was the proportion of surgical success based on intraocular pressure (IOP), surgical complications, the need for revision surgery, loss of light perception and the need for additional pressure-lowering medication.ResultsThe mean follow-up time was 6 (±0.8, IQR: 5.4–6.5) years. Seventy-three per cent of eyes achieved qualified surgical success at the last follow-up (IOP≥5 mm Hg and ≤18 mm Hg, without surgical complications or complete loss of vision) but necessitated additional medical therapy, complete surgical success with no additional medical therapy was achieved in 69% of eyes. There was no significant difference in the success probability between eyes that had undergone cataract surgery after TE and those that had not (p=0.45).ConclusionsThe results demonstrate a high and stable success rate of TE after a mean follow-up time of approximately 6 years, that is, not affected by later cataract surgery.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

et al. 2023

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“…However, trabeculectomy was also performed at the local tertiary eye center on these two patients, and according to the medical record, surgical procedures, including mitomycin C dose, were also similar to those of our hospital. Previous studies showed that the results of trabeculectomy performed by residents or trainees can also have a high success rate [ 18 , 19 ]. We believed that the failure after single trabeculectomy in patients with ARB may not be affected by the different surgeons.…”

Section: Discussionmentioning

confidence: 99%

Combination of Trabeculectomy and Primary Pars Plana Vitrectomy in the Successful Treatment of Angle-Closure Glaucoma with BEST1 Mutations: Self-Controlled Case Series

et al. 2022

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Introduction: This study aimed to illustrate the efficacy of the combination of lens extraction, trabeculectomy, and anterior vitrectomy in patients with secondary angle-closure glaucoma (ACG) with autosomal recessive bestrophinopathy or Best vitelliform macular dystrophy. Methods: This is a retrospective self-controlled case series study. Five patients undergoing a single trabeculectomy in one eye and triple surgery in the other eye were enrolled. All patients underwent a complete ophthalmic examination that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), ultrasound biomicroscopy, and static gonioscopy. Multimodal fundus imaging was performed, including color fundus photography, fundus autofluorescence, and optical coherence tomography. Genetic testing was also analyzed. Results: Among the 10 eyes, the mean IOP was 31.4 ± 4.7 mmHg before surgery. The mean axial length (AL) was 21.53 mm and the anterior chamber depth (ACD) was 2.31 mm. There were no statistically significant differences in preoperative IOP, BCVA, ACD, and AL between the two groups (all P [ 0.05). The mean followup time was 64.0 months. All five eyes with a single trabeculectomy developed malignant glaucoma (MG). No complications were found in the other five eyes with triple surgery, and the anterior chamber was deepened and stable after surgery until the last visit. The mean IOP at the last visit was normalized to 16 mmHg without using any medications. Conclusions: Triple surgery is superior to single trabeculectomy for patients with ACG and BEST1 mutation, effectively bypassing MG complications. The vitreous may play a vital role in the mechanism of ACG in those patients and the high incidence of MG after filtering surgery.

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“…A few studies compared the outcomes of trabeculectomy between residents and glaucoma specialists, mainly in the United States. While some report comparable results, others state higher complication and reintervention rates in resident-performed trabeculectomy 4,9–16…”

mentioning

confidence: 99%

“…While some report comparable results, others state higher complication and reintervention rates in resident-performed trabeculectomy. 4,[9][10][11][12][13][14][15][16] Therefore, the purpose of this study was to compare the outcomes of ab externo trabeculectomy between resident trainees and staff ophthalmologists in a Portuguese teaching hospital and tertiary center.…”

mentioning

confidence: 99%

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Lima-Fontes¹,

Faria-Pereira²,

Leuzinger-Dias³

et al. 2022

Journal of Glaucoma

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Précis: Resident-performed trabeculectomies present higher intraocular pressure and lower complete success rate at 1 year. Purpose: To compare the 1-year outcomes of ab externo trabeculectomy between residents in training and staff ophthalmologists. Patients and Methods: This retrospective study included all consecutive eyes submitted to ab externo trabeculectomy between January 2015 to June 2020. A 1-year complete success rate was considered using all the following criteria: intraocular pressure (IOP)≤21 mm Hg and ≥6mm Hg without ocular hypotensive medications; IOP reduction≥30%; without loss of light perception, phthisis bulbi, and further glaucoma surgery (excluding suture lysis and bleb needling). Results: One hundred and ten eyes from 99 patients were included. Thirty percent (n=33) of the trabeculectomies were performed by residents. There were no significant preoperative differences between groups, apart from age at surgery, which was higher in the residents' group (72.39±6.83 vs. 62.00±15.07 years, P<0.001), and visual field index (Humphrey Field Analyzer), which was lower in the ophthalmologists’ group (51.81±34.74% vs. 32.04±33.83%, P=0.013). IOP at 1-, 3-, 6 months, and 1 year after surgery was significantly higher in the resident’s group (P<0.05). Resident-performed trabeculectomies achieved a significantly lower complete success rate when compared with the ophthalmologists’ group (39.39% vs. 64.94%, P=0.013). The overall rate of the postoperative complications and reintervention did not differ between groups, but the occurrence of a shallow anterior chamber was more frequent in the residents’ group (15.15% vs. 4.05%, P=0.037). Conclusions: Resident-performed trabeculectomies present significantly higher postoperative IOP levels and a lower complete success rate when compared with staff ophthalmologists. It is, therefore, fundamental to adopt strategies to change this gap, improve patient safety, and strengthen resident confidence.

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Outcomes of primary trabeculectomy with mitomycin-C for primary angle closure glaucoma among supervised trainees in a tertiary eye center in Manila

Cited by 4 publications

References 13 publications

Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

Combination of Trabeculectomy and Primary Pars Plana Vitrectomy in the Successful Treatment of Angle-Closure Glaucoma with BEST1 Mutations: Self-Controlled Case Series

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

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