PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Trabeculectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1990

The long-term effect on intraocular pressure of a procedure combining trabeculectomy and cataract surgery, as compared with trabeculectomy alone.

The long-term reduction of intraocular pressure (IOP) resulting from a procedure combining extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was compared retrospectively with the IOP-lowering effect of trabeculectomy alone. Forty patients who underwent the combined procedure and 38 who underwent trabeculectomy alone had been followed for an average of 22 +/- 7 months. Both these surgical procedures significantly reduced IOP, but after a year or more, pressure levels were significantly lower in the trabeculectomy group than they were in the combined group: 12.8 +/- 4.2 mm Hg, and 16.5 +/- 5.6 mm Hg, respectively, at 18 months. Also, the mean postoperative fall in IOP was greater in the "filtered" eyes than it was in the combined group (9.8 +/- 4.6 mm Hg and 12.1 +/- 5.2 mm Hg, respectively, at 18 months). Finally, the number of medications required to maintain controlled IOP in the combined group was greater (and resumed preoperative values at 2 years) than it was in the trabeculectomy group (62.5% of the filtered eyes remained controlled unaided).

Aged↗
PubMed1979

Trabeculectomy and modifications of trabeculectomy.

Seventy-four trabeculectomies have been reviewed and discussed. Intraocular pressure 20 mm Hg or lower was achieved in 74.2% at the end of six months and in 66% one year postoperatively. The influence of age and sex on postoperative maintainance of intraocular pressure has also been discussed. There was not a statistical difference in results when the sex of the patients were compared. Patients under age forty did poorly in this series as compared to patients over age forty-one. Tenonectomy and cautery to the posterior edges of the scleral flap have been beneficial. The insertion of a gel film or silastic implant under the posterior edge of the scleral flap has been studied but in too few patients to draw any valid conclusions. In general, our results have been satisfactory with very few operative or postoperative complications.

Adult↗
PubMed1975

Trabeculectomy: a re-evaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to and including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in cases of primary glaucoma treated with a Scheie procedure and 16 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior changes than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye; (2) chronic angle closure glaucoma where an iridectomy is considered insufficient; (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential; (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery; and (5) cases where endophthalmitis is a real concern, as in the very young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Administration, Topical↗
PubMedDate not supplied

Trabeculectomy: a reevaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to an including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in patients with primary glaucoma treated with a Scheie procedure and 16.6 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior chambers than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye, (2) chronic angle-closure glaucoma where an iridectomy is considered insufficient, (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential, (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery, and (5) patients where endophthalmitis is a real concern, as in the young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Adolescent↗
PubMed1989

Long-term results of 5-fluorouracil trabeculectomy for primary open-angle glaucoma.

The effect of 5-fluorouracil (5-FU) subconjunctival injection on the bleb formation and intraocular pressure (IOP) following trabeculectomy was studied in 27 primary open-angle glaucoma patients (33 eyes) who had never been operated upon (25 eyes) or had undergone single trabeculectomy that failed to reduce IOP (8 eyes). The results were analyzed by means of life table analysis and compared with those of 65 primary open-angle glaucoma eyes that had undergone trabeculectomy without postoperative administration of 5-FU as the first or the second filtering surgery. The surgical techniques and postoperative care were virtually identical between the eyes treated with 5-FU and the eyes that had undergone trabeculectomy without 5-FU. At the end of 28-month follow-up, the success probability was 74.8% without any postoperative antiglaucoma medication, and 100% with antiglaucoma medication. Whereas, the success probability with postoperative antiglaucoma medication was as low as 60.8% for the first, and 51.5% for the second trabeculectomy without 5-FU at the 24-month follow-up. Postoperative, subconjunctival injection of 5-FU appears to improve the prognosis following trabeculectomy in primary open-angle glaucoma patients.

Adult↗
PubMed1989

Primary trabeculectomy in congenital glaucoma.

The reported success rates in the treatment of congenital glaucoma with goniotomy, trabeculotomy, and trabeculectomy suggest that trabeculectomy should be performed if the other procedures fail. We propose that the decision to perform primary trabeculectomy in primary and secondary congenital glaucoma reduces the effect which the many variable findings in surgical anatomy may have on the outcome of other procedures. This is a retrospective study of the results of primary trabeculectomy in 21 consecutive eyes of 15 patients with congenital glaucoma. Eighteen of 13 patients' eyes were controlled after a single trabeculectomy and remained controlled after a mean follow-up of 3.9 years (range 1.5 to 6.7 years). The role of primary trabeculectomy in congenital glaucoma merits further consideration.

Child↗
PubMed1990

The influence of prior therapy on the success of trabeculectomy.

The role of early surgery in the management of primary open angle glaucoma is under debate. To determine whether previous medical therapy influences the outcome of subsequent trabeculectomy, we retrospectively reviewed the results of surgery in two groups of patients. The first group underwent primary trabeculectomy, having had an average of 2 weeks of preoperative medical therapy, and this group was compared with a group of patients who had received at least 1 year of topical glaucoma therapy before undergoing trabeculectomy (the multiple-treatment group). The two groups were similar in terms of a number of variables, including race, age, sex, presenting intraocular pressures, and presenting visual fields, and they differed only in the known duration of their disease. The success rate of trabeculectomy was significantly higher in the primary trabeculectomy group as compared with that in the multiple-treatment group (P less than .001). We discuss the possible reasons for this difference and its implications for the future management of primary open angle glaucoma.

Aged↗
PubMed1989

Effect of postoperative subconjunctival 5-fluorouracil injections on the surgical outcome of trabeculectomy in the Japanese.

A controlled study was carried out to evaluate the effect of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcomes of trabeculectomy in the Japanese (a total of 196 eyes in 157 patients). The eyes that had undergone trabeculectomy with postoperative 5-FU (5-FU group) included 36 eyes with primary open-angle glaucoma (POAG) and 17 with secondary glaucoma (SG) undergoing their first or second trabeculectomy. There were also 34 eyes with refractory glaucoma. The eyes that had had trabeculectomy without postoperative 5-FU (control group) included 46 POAG and 31 SG eyes undergoing their first or second trabeculectomy and 24 refractory glaucoma eyes. The surgical techniques and postoperative care were virtually identical between the two groups, except that the control group did not receive 5-FU. The results were analyzed by means of a life table method and a postoperative intraocular pressure (IOP) level equal to or less than 20 mmHg was adopted as the criterion for successful IOP control. In the 5-FU group, the success probability (%) at the 3-year follow-up was 93.9 +/- 4.2 (SE) for POAG eyes, 93.8 +/- 6.1 for SG eyes, and 86.7 +/- 5.6 for refractory glaucoma eyes. In the control group, it was 55.0 +/- 7.9, 37.2 +/- 13.5, and 16.1 +/- 7.4, respectively. The difference in success probability between the 5-FU and control groups was highly significant (P less than 0.001 or 0.01). In the POAG and SG eyes, the mean postoperative IOP was significantly lower in the 5-FU group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil.

The incidence of late-onset bleb-related endophthalmitis was evaluated retrospectively in 229 consecutive trabeculectomies performed with adjunctive 5-fluorouracil (5-FU) therapy. Mean follow-up was 23.7 +/- 16.3 months (range, 3 to 60 months). Thirteen eyes (5.7%) of 11 patients developed bleb-related endophthalmitis an average of 25.9 +/- 17.4 months (range, 5 to 58 months) after surgery. Infection occurred in 9 of 96 (9.4%) procedures performed from below and in 4 of 133 (3.0%) procedures performed superiorly (P = 0.05, Fisher's exact test). The relative risk of bleb-related endophthalmitis in trabeculectomy from below versus above is 4.0 after adjustment for age and sex (95% confidence interval = 1.1, 14.8). Trabeculectomy with adjunctive 5-FU performed from below carries an increased risk of late bleb-related infection. The incidence of late bleb-related endophthalmitis after 5-FU trabeculectomy appears to be higher than that for trabeculectomy without adjunctive 5-FU injections.

Adolescent↗
PubMed1991

Complications of 5--fluorouracil after trabeculectomy.

Trabeculectomy has a very high success rate, however, certain eyes are known to be at high risk of failure due to scarring of the conjunctival bleb. Such eyes include those with a previous failed filter, eyes with glaucoma secondary to uveitis and neovascularisation and the eyes of children and young adults. Trabeculectomy is generally accepted to have less successful results in patients of African race although good results are reported from some centres. The effectiveness of treatment with 5-fluorouracil in improving the results of trabeculectomy has been established in a number of pilot studies and clinical trials. Early studies used 100 mg of 5-fluorouracil in divided doses. Serious complications were recorded and lower dose regimes have been advised to improve the safety of the technique. Similar success in improving the chance of success to trabeculectomy has been found with doses of 40 mg with a lower incidence of side effects. We report complications associated with the use of 5-fluorouracil in a total dose of 50 mg in a group of 49 eyes undergoing trabeculectomy and postoperative 5-fluorouracil and describe the previously unreported increased incidence of thin cystic blebs in these eyes.

Adolescent↗
PubMedDate not supplied

[The extraction of the crystalline lens with trabeculectomy in open-angle glaucoma].

Trabeculectomy with the extraction of the crystalline in a single operating tempo, represents a progress in the solving of two affections through a single intervention. Of the total of 101 cases of open-angle glaucoma operated and analysed on 21 patients, trabeculectomy was practised in the extraction of the crystalline (21%). The ocular tension before the operation was between 21-30 mm Hg, on 15 patients, 31-40 mm Hg, on 4 patients and over 41 mm Hg on 2 patients. As to the visual acuity, it was below 1/50, due to the opacity of the crystalline and the advanced stage of the glaucoma. The technicality varied, according to the operator--either classical Cairns trabeculectomy, or Franimopoulos-protected trepano-trabeculectomy followed by the extraction of the intracapsulated crystalline. Small postoperation hemorrhages appeared in 6 of the cases observed in the anterior chamber and 4 small hemorrhages in the vitreous body were resorbed in 7-10 days. In all cases under observation, the postoperative ocular tension kept within 11 to 17 mm Hg. The extraction of the crystalline with trabeculectomy in open-angle glaucoma is easily performed and complications are not more frequent than in the simple extraction of the crystalline.

Aged↗
PubMed1975

[Cataract surgery and trabeculectomy at the same time (author's transl)].

It is not unusual to observe in the same eye a chronic glaucoma and a cataract. Surgery may be indicated for one of these diseases separately or for both of them. For simultaneous operation on glaucoma and cataract several attitudes could be discussed: a) cataract surgery and medical treatment of glaucoma, b) glaucoma surgery at first and then cataract surgery, c) cataract and glaucoma surgery at the same time. Since trabeculectomy is used for glaucoma surgery, the author performs the combined method, i.e. the simultaneous lens extraction and the operation of glaucoma through trabeculectomy. The advantages of trabec-lectomy over the other techniques for glaucoma surgery indicated that trabeculectomy over the other techniques for glaucoma surgery indicated that trabeculectomy is the best technique to be used in association with intracapsular cataract extraction. Our material consists of 65 patients, amongst which there are 11 patients with diabetes. 91 eyes have been operated upon during the last 2 years. Most of the postoperative complications, i.e. hyphaema, vitreous haemorrhage and prolapse, pupillary block, postoperatve rise of i.o. pressure are not severe and have no influence in the desired fall of i.o. pressure. It may be pointed out that a permanent regulation of i.o. pressure often occurs only 3 months postoperatively. Finally it can be said that the trabeculectomy associated with intracapsular cataract extraction appeared to be the best operation in case of glaucoma and cataract, provided that on the one hand the vascular status of these patients is controlled and on the other hand the operation microscope is exclusively used in surgery of the trabeculum.

Cataract↗
PubMed1976

Further experience with trabeculectomy.

Trabeculectomies performed on 33 eyes were compared to 28 standard filtering procedures done at the same institution during a 4 year period. The success rates in the two groups of patients whether white or black were statistically comparable, 92% in the trabeculectomy group and 77% in the standard filtering surgical group. Only cases of phakic open angle glaucoma, chronic angle closure and combined mechanism glaucoma were considered. Cases of secondary glaucoma, previous surgical failure and aphakic nonpupillary block glaucoma did uniformly poorly. When trabeculectomy was performed with "enhanced cyclodialysis" early results in a few cases were successful. The incidence of flat anterior chamber and cataracts with permanent reduction in visual acuity was significantly less in the trabeculectomy group than in the standard filtering procedure group. These results support previous studies which support trabeculectomy as successful as standard filtering procedures with the advantage of having fewer permanent serious complications.

Adult↗
PubMed1992

Application of hyaluronidase after unsuccessful trabeculectomy.

Trabeculectomy fails to control the intraocular pressure (IOP) adequately in some cases. The effect of the enzyme hyaluronidase--300 IU Hylase 'Dessau' (commercially available ampuls)--applied in subconjunctival injection in the region above the filtering bleb in case of postoperative rise in IOP following trabeculectomy was studied. Successful IOP control was defined as an IOP below or equal to 20 mmHg with or without medication. The investigation concerned 62 eyes (46 patients) with primary open angle glaucoma (POAG) divided in three groups: Group I--39 eyes with early postoperative rise in IOP (7-20 days postoperatively), group II--15 eyes with late rise in IOP (6 months-1 year after surgery), group III--8 eyes with one previous unsuccessful trabeculectomy. In all examined cases IOP was over 20 mmHg (mean IOP was 26.23 +/- 3.46 mmHg) postoperatively before application of hyaluronidase. The follow up period ranged from 6 to 34 months. We found statistically significant lowering in IOP in group I (p < 0.01), group II (p < 0.05) and group III (p < 0.05). Complications related to the use of hyaluronidase were not observed up to now. Postoperative subconjunctival injection of hyaluronidase appears to improve the prognosis following unsuccessful trabeculectomy in POAG patients.

Adult↗
PubMed1991

The effect of trabeculectomy on the aqueous humor flow of the unoperated fellow eye.

Computerized anterior-chamber fluorophotometry was used to investigate the effect of unilateral antiglaucomatous trabeculectomy on the dynamics of aqueous humor in the unoperated fellow eye. In 14 patients with bilateral primary open-angle glaucoma, pigmentary glaucoma or exfoliation glaucoma, antiglaucomatous trabeculectomy was performed in one eye in which medical management of glaucoma had failed. The fellow eye in all patients had a well-defined history of glaucoma and had been treated with different sorts of medication. The medical management of the unoperated fellow eyes was continued throughout the study. Aqueous humor flow was measured in these eyes prior to surgery and on the 5th day after trabeculectomy. Systemic medication was discontinued from 48 h prior to surgery until second fluorophotometry. The average postoperative flow in the fellow eyes increased from 2.56 to 2.92 microliters/min (P less than 0.05%, paired t-test). The increase in flow in the fellow eyes was independent of topical antiglaucoma medication and of the diurnal rhythm of aqueous humor dynamics. The results of the study indicate that filtration surgery in one eye triggers a CNS-mediated, reflective increase in aqueous flow to maintain physiological stability in the anterior chamber of the surgically treated eye. Since this CNS reflex on aqueous humor dynamics affects both eyes, the clinical observation of intraocular pressure (IOP) dysregulation in the unoperated fellow eye following unilateral trabeculectomy is now understandable.

Adult↗
PubMed1989

Risk factors for the development of Tenon's capsule cysts after trabeculectomy.

Tenon's capsule cysts (TCCs) are a complication of glaucoma filtering surgery. They are frequently associated with substantial elevations in intraocular pressure (IOP) beginning 2 to 8 weeks postoperatively. To determine the incidence and possible risk factors for the development of TCCs, case records of all patients who received trabeculectomy over a 4-year period at the Wills Eye Hospital were reviewed. The incidence of TCCs was 28% in those who underwent trabeculectomy. Characteristics of patients after trabeculectomy in whom TCCs developed were compared with patients after trabeculectomy in whom TCCs did not develop. Both univariate and multivariate techniques were used to assess the association of characteristics associated with the development of TCCs. Factors associated with increased risk (P less than 0.05) were: history of prior TCCs, argon laser trabeculoplasty, male gender, and the use of preoperative sympathomimetics. The use of a compression shell was associated with decreased risk (P less than 0.05).

Adult↗
PubMed1990

Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma.

From May 1981 to Feb. 1989 trabeculectomy with per-operative topical application of mitomycin C was performed on eyes with refractory glaucoma. All eyes had undergone prior one, two or more than two antiglaucoma surgeries without success for IOP control. Other risk factors in the present series of eyes included young age, aphakia, rubeosis and glaucoma secondary to trauma or associated with anterior uveitis. 59 eyes underwent trabeculectomy with mitomycin application. 14 eyes were lost. 45 eyes of 42 cases, 33 eyes of 31 males and 12 eyes of 11 females were followed for a period of 1 to 8 years, an average 3.0 +/- 1.9 years. The success for IOP control less than 21 mmHg was 77.8%, 35/45 eyes. The success rates were 92%, 11/12 eyes in females and 73%, 24/33 eyes in males. Complications reported in 5-fluorouracil studies such as corneal epithelial toxicity and delayed healing of conjunctival wound were not encountered. The histo-pathological changes of wound healing after trabeculectomy with topical mitomycin application was discussed. In the healing process success to achieve filtration is more likely by pharmacolocally interferring with earlier steps in the process. We recommend the use of per-operative topical application of mitomycin C during trabeculectomy in eyes with uncontrolled glaucoma and poor prognosis, specifically after previous cataract extraction or unsuccessful antiglaucoma surgery.

Adolescent↗