Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.
Human ; Aged ; Middle Aged ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY ; FILTERING SURGERY

BACKGROUNDNon-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma.

METHODSThe published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis.

RESULTSA total of 37 articles were included in the meta-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7% (95% CI: 58.5% - 81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0% - 71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8% - 85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6% - 86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4% - 74.3%).

CONCLUSIONSNon-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.

Human ; Adult ; GLAUCOMA-OPEN-ANGLE ; GLAUCOMA,SIMPLEX ; GLAUCOMA, COMPENSATED ; IRIDOCORNEAL ENDOTHELIAL SYNDROME ; FILTERING SURGERY ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY

Intraoperative mitomycin c has been popularized for use as an adjuvant to increase the success rate of trabeculectomy because of its antifibroblastic effects. Basically it has a potent antifibroblastic effect and its use presents many potential problems and side effects. As a result, many surgeons concentrate on method to gain the optimal surgical results with the minimal complications with MMC. But the long-term effects of MMC have not been determined because of its short history of clinical applications. So, we evaluated the surgical results and complications of MMC in a long-term follow-up study (more than 30 months) , which was divided into 4 groups by the use of MMC and the high-risk characteristics. A total of 135 eyes were studied. Each group included: A, 40 eyes; B, 17 eyes; C, 52 eyes; D, 26 eyes. Failed filtering surgery and young age were major factors in high-risk groups. In high-risk groups (A, B), the difference in success rates was statistically significant A(M+), 88.5%; B(M-), 52.9% (p=0.010), but in non-high risk groups (C, D), it was not: C(M+), 75%; D(M-), 76.9% (p=0.852). The difference in isual acuity (more than 3 lines in a snellen chart) between each groups was not shown. And in non-high risk groups (C, D), the difference in the hypotony rate was statistically significant C(M+), 21%; D(M-), 49% (p=0.046), but in high-risk groups, it was not: A(M+), 15%; B(M-), 11% (p=0.748). Regardless of the preoperative IOP level, postoperative IOP was less in cases where MMC was used than in cases where MMC was not used. In conclusion, MMC increased the success rate in high-risk groups but it aggravated complications, especially in non-high risk groups. To get optimal results with minimal complications, discreet use of MMC in selected cases is highly recorninended.
Filtering Surgery ; Follow-Up Studies* ; Mitomycin* ; Trabeculectomy*

The purpose of this study was to determine whether preoperative topical antiglaucomatous therapy influences the outcome of subsequent trabeculectomy. We investigated 50 eyes of 36 patients with primary open anlge glaucoma(POAG)and 86 eyes of 77 patients with primary angle closure glaucoma (PACG), who had undergone trabeculectomy. All the patients had received topical antiglaucomatous therapy preoperatively and had been followed up for at least 6 months postoperatively. Both groups, POAG and PACG were divided into two subgroups according to the duration of preoperative antiglaucomatous therapy: (a)for less than 1 month and (b)for more than 6 months. The criterion for success was maintenance of postoperative intraocular pressure(IOP)below 21 mmHg without medication. The rates of success were compared at 1 week, 1 month, 3 months, and 6 months postoperatively. In POAG patients, the overall success rate was clinically significantly higher in subgroup (a)than in subgroup (b)(P<0.05). The success rate in subgroup (a)of POAG patients remained higher irrespective of class of antiglaucomatous medications(P<0.05). In PACG patients, the success rate was also higher in subgroup A, but it failed to reach clinical significance. Postoperative mean IOP was slightly lower in subgroup (a)of all the participants, but it was not clinically significant. Our study suggests that long-term use topical antiglaucoma medications can affect adversely the result of filtering surgery in POAG.
Filtering Surgery ; Glaucoma, Angle-Closure ; Humans ; Trabeculectomy*

Endophthalmitis following the filtering surgery is rare and the visual prognosis is reported to be very poor. In many cases the infection starts in the bleb. Methods of treatment should be chosen according to the type and stage of infection, but the prompt use of appropriate antibiotic and corticosteroid is important. This report presents a case of endophthalmitis following trabeculectomy in a 61-year old female patient, which was successfully treated.
Blister ; Endophthalmitis* ; Female ; Filtering Surgery ; Humans ; Middle Aged ; Prognosis ; Trabeculectomy*

Endophthalmitis is a severe and unfortunate complication after glaucoma filtering surgery which may present months to years after the initial surgical intervention. Amniotic membrane is immunologically inert and has antiadhesive and wound-protectioning effects. Furthermore, it reduces pain and helps epithelization. So several reports disclosed the uses of amniotic membrane in transplantation for reconstruction of various ocular surface diseases recently. We report the usefulness of antibiotics-soaked amniotic membrane transplatation for endophthalmitis with bleb rupture 4 years after trabeculectomy.
Amnion* ; Blister ; Endophthalmitis* ; Filtering Surgery ; Glaucoma ; Rupture ; Trabeculectomy

Usual managements of flat anterior chamber following filtering surgery are deepening of anterior chamber using cycloplegics and mydriatics, and pressure patch technique compressing the fistula. But the pressure patch technique may worsen chamber depth problem because exact compression on the filtering area is difficult by pressure patching. Prolonged pressure patching may also cause deterioration of filtering function. The tampon with glaucoma shell provides enough resistance to excessive outflow, allows the anterior chamber to reform promptly, and can prevent choroidal separation. We treated the flat anterior chamber following trabeculectomy using glaucoma shell in 7 eyes. The anterior chamber in each eye was restored promptly within 2-4 days after the placement of glaucoma shell. Glaucoma shell is easy to handle, gives minimal discomfort to patient, and may need less time to restore flat anterior chamber than pressure patching.
Anterior Chamber* ; Choroid ; Filtering Surgery ; Fistula ; Glaucoma* ; Humans ; Mydriatics ; Trabeculectomy*

PURPOSE: To evaluate the outcome of Ahmed valve implantation as a primary or secondary glaucoma surgery to treat refractory glaucoma patients. METHODS: A total of 101 eyes of 101 patients with refractory glaucoma, who received Ahmed valve implantation between March 1995 to September 2004 were included. We divided cases into primary surgery group, who had no trabeculectomy, and secondary surgery group, who had trabeculectomy before Ahmed valve implantation. Successful operation was defined as having the following outcomes: (1) postoperative intraocular pressure (IOP) sustained between 5 and 21mmHg and reduced 30% from the baseline IOP with or without medication, (2) no visual decline due to IOP or complications, and (3) no additional filtering surgery. Clinical records were reviewed, and IOP, antiglaucoma medications, and complications were recorded. Kaplan-Meier survival analysis was used to calculate the overall probability of success. RESULTS: In primary surgery group, overall success rate was 57.6%, 46.7%, 39.7%, and 39.7% at 1, 3, 5, and 7 years, respectively. In secondary surgery group, overall success rate was 67.8%, 58.1%, 52.4%, and 43.5% at the same time points. There was, however, no statistical difference in success rates between two groups. The incidence of complications were as follows: 4.2% of endophthalmitis, 4.2% of valve exposure, 4.2% of hypotony was found in the primary surgery, and 3.8% of endophthalmitis, 1.9% of valve exposure, 9.4% of hypotony were found in the secondary surgery. There were no statistical differences in the incidences of complications between the two groups. CONCLUSIONS: Ahmed valve implantation was effective for IOP control in refractory glaucoma patients. Success rate did not show significant difference between primary and secondary Ahmed valve implantation group.
Endophthalmitis ; Filtering Surgery ; Glaucoma* ; Humans ; Incidence ; Intraocular Pressure ; Trabeculectomy

No Abstract Available.
Filtering Surgery* ; Genistein* ; Glaucoma*