BACKGROUNDPhacotrabeculectomy can be performed using one-site or two-site incisions. This meta-analysis evaluated the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with coexisting cataract and glaucoma.

METHODSA comprehensive literature search was performed according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials comparing one-site with two-site phacotrabeculectomy. Studies meeting our predefined criteria were included in the meta-analysis. Efficacy estimates were measured by weighted mean difference (WMD) for the percentage intraocular pressure (IOP) reduction from baseline to end point, relative risk (RR) for the proportion of patients with a best-corrected visual acuity (BCVA) of 0.5 or better after surgery and complete success rates. Tolerability estimates were measured by RR for adverse events. All of outcomes were reported with 95% confidence interval (95%CI). Data were synthesised by Stata 10.1 for Windows.

RESULTSTwo-site phacotrabeculectomy was associated with greater reductions in IOP than the one-site procedure (WMD: -5.99, 95%CI: -10.74 - -1.24, P = 0.01). A greater proportion of patients also achieved a BCVA of 0.5 or better (RR: 0.91, 95%CI: 0.74 - 1.12, P = 0.36) and the target IOP without anti-glaucoma medication at the study end point (RR: 0.94, 95%CI: 0.83 - 1.07, P = 0.34) after two-site than one-site phacotrabeculectomy, but the differences were not significant. There were no significant differences in adverse events between two surgical procedures.

CONCLUSIONSTwo-site phacotrabeculectomy is superior to one-site phacotrabeculectomy in reducing IOP, but other post-operative effects are similar. One-site and two-site phacotrabeculectomies have similar adverse event rates.

Humans ; Trabeculectomy ; adverse effects ; methods

BACKGROUNDSurgical interventions are the main treatment for primary congenital glaucoma (PCG). This study aimed to compare the efficacy and safety between viscocanalostomy and mitomycin C (MMC)-trabeculectomy in patients with PCG.

METHODSA total number of 43 patients with PCG who underwent either viscocanalostomy (group 1) or MMC- trabeculectomy (group 2) between June 2003 and June 2008 were retrospectively reviewed. The patients' intraocular pressures (IOPs) were examined before surgery and on day 1, week 1, month 1, month 6, and month 12 post-operative. Mean horizontal corneal diameters, success rates, intra- and post-operative complications were compared between the two groups.

RESULTSPre-operative IOPs were (31.96 ± 3.90) mmHg in group 1 and (32.56 ± 4.00) mmHg in group 2. At the last visit, IOPs were (16.78 ± 2.20) mmHg and (15.77 ± 2.60) mmHg, respectively (P < 0.001); the complete success rates of group 1 and group 2 were 45.9% and 67.4%, respectively, and the difference was not statistically significant (P = 0.158). There were no major complications occurred in the two groups.

CONCLUSIONSBoth viscocanalostomy and trabeculectomy can lower IOP in PCG patients effectively. Although there was no major complications occurred in both groups, viscocanlostomy may decrease the probability of postoperative haemorrhage, hypotony, cataract, or choroid effusion.

Female ; Filtering Surgery ; adverse effects ; methods ; Glaucoma ; congenital ; surgery ; Humans ; Infant ; Intraocular Pressure ; Male ; Retrospective Studies ; Trabeculectomy ; adverse effects ; methods

BACKGROUNDTrabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

METHODSThis is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

RESULTSAfter 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

CONCLUSIONPhacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Aged ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Trabeculectomy ; adverse effects ; methods ; Visual Acuity

BACKGROUNDBleb-associated endophthalmitis (BAE) is a rare but severe complication of trabeculectomy with poor outcome. Various surgical methods were explored to treat such patients. However, there is no defined protocol. The aim of this study was to describe a new combined operation, and to demonstrate the outcome of the treatment.

METHODSNine patients with BAE were enrolled in our study. The combined operation including pars plana vitrectomy (PPV), sclera patch graft (SPG) and endoscopic cyclophotocoagulation (ECP) was used to treat these patients.

RESULTSIn the follow-up of 18 - 24 months, all patients with the endophthalmitis were cured, the useful visual acuity was preserved in 7 patients, and the intraocular pressure (IOP) of 8 patients was controlled just after first operation, only one needed another trans-scleral cyclophotocoagulation.

CONCLUSIONThis combined operation is a useful method for treating the patients with BAE, with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative IOP.

Adolescent ; Adult ; Child ; Endophthalmitis ; surgery ; Female ; Glaucoma ; surgery ; Humans ; Male ; Trabeculectomy ; adverse effects ; Visual Acuity ; physiology ; Vitrectomy ; methods ; Young Adult

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

The occurrence of ptosis after trabeculectomy has been a common postoperative complication. Many factors have been implicated in the development of postoperative ptosis. The purpose of this study was to investigate the incidence of ptosis following trabeculectomy and whether or not it was influenced by combined cataract surgery, type of conjunctival flap, and previous intraocular surgery. We reviewed 386 eyes of 386 patients who underwent either trabeculectomy alone or trabeculectomy combined with cataract surgery, with greater than 6 month follow-up. Ptosis occurred in 10.7% (18 of 150 eyes) after trabeculectomy alone and in 12.7% (30 of 236 eyes) after trabeculectomy with combined cataract surgery (p = 0.96). The incidence of ptosis was 12.3% (10 of 81 eyes) after limbus-based conjunctival flap and 12.5% (38 of 305 eyes) after fornix-based conjunctival flap (p = 0.98). There was no significant difference in the incidence of ptosis between primary surgery eyes (12.5%, 34 of 273 eyes) and secondary surgery eyes (12.4%, 14 of 113 eyes) (p = 0.97). The incidence of ptosis after trabeculectomy was about 12% overall and not significantly influenced by combined cataract surgery, type of conjunctival flap or previous ocular surgery.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blepharoptosis/*etiology ; Cataract Extraction/adverse effects/methods ; Female ; Follow-Up Studies ; Glaucoma/surgery ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Trabeculectomy/*adverse effects

BACKGROUNDThe existing classifications for evaluating glaucoma filtering blebs rely mostly on external bleb characteristics and the postoperative control of intraocular pressure (IOP). Internal bleb structures are not carefully observed. This study aimed to analyze and compare glaucoma filtering bleb morphology using slit-lamp-adapted optical coherence tomography (SL-OCT) and ultrasound biomicroscopy (UBM), and to classify blebs according to results and intraocular pressure.

METHODSWe followed 29 eyes of 21 male patients and 40 eyes of 32 female patients who underwent glaucoma filtering surgery in Sixth People's Hospital of Shanghai, between 2002 and 2006. The blebs were imaged using SL-OCT and UBM and classified according to the intrableb morphology and control of IOP after surgery. A Fisher's exact test was used to compare the sensitivity for predicting a functioning bleb differed significantly between SL-OCT and UBM. A Fisher's exact test was also used for morphological analysis of the trabeculectomy blebs based on SL-OCT.

RESULTSIn the 69 eyes, there were 45 (65.2%) functioning blebs and 24 (34.8%) non-functioning blebs. We classified the blebs into four categories on the basis of SL-OCT images: diffuse, cystic, encapsulated and flat. Diffuse and cystic blebs were typically functional, whereas the other two types were always non-functional. The sensitivity of SL-OCT for predicting a functioning bleb was 92.7% (38/41 eyes) and specificity of predicting a non-functioning bleb was 83.3% (20/24 eyes). By contrast, sensitivity of UBM was 66.7% (30/45 eyes) and specificity was 75.0% (18/24 eyes). The sensitivity for predicting a functioning bleb differed significantly between the two techniques (P = 0.003).

CONCLUSIONSSL-OCT provides high-axial-resolution images of anterior segment structures. The non-contact approach of SL-OCT enables visualization of intrableb structures at any time after surgery. SL-OCT has greater sensitivity and specificity than UBM in evaluating filtering bleb function. The morphological classification supported the assessment of bleb function and could provide objective data for evaluating the outcome of antiglaucoma surgery or the need for a second procedure.

Adult ; Aged ; Aged, 80 and over ; Blister ; pathology ; physiopathology ; Conjunctiva ; pathology ; physiopathology ; Female ; Glaucoma ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Microscopy, Acoustic ; methods ; Middle Aged ; Reproducibility of Results ; Tomography, Optical Coherence ; methods ; Trabeculectomy ; adverse effects ; methods

OBJECTIVETo evaluate the efficacy of "straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with mitomycin C (MMC) on reducing intraocular pressure (IOP), complications, and corneal astigmatism in patients with primary angle-closure glaucoma (PACG).

METHODSTotally 217 acute or chronic PACG patients with occludable angle above 180 degrees and IOP above 21 mm Hg were divided into 3 groups. Patients in group A (98 cases, 128 eyes), B (71 cases, 95 eyes), and C (48 cases, 60 eyes) were treated with "straight scleral tunnel incision"-trabeculectomy with a releasable suture supplemented with MMC, releasable suture trabeculectomy with MMC, and trabeculectomy with MMC, respectively. IOP, complications, and surgically induced astigmatism (SIA) were evaluated preoperatively and up to 12 months postoperatively.

RESULTSIOP of 2 weeks after treatment was significantly lower than preoperative IOP in all the 3 groups (all P <0. 001). Success rates (IOP < or = 20 mm Hg) in group A, B, and C were 87.91%, 89.23%, and 83.72% respectively at 12 months after treatment (P = 0.256). The incidence of shallow anterior chamber and hypotony had no significant difference between group A and B, but both of them were lower than that in group C (P < 0.05). There were no significant differences in preoperative corneal astigmatism among the 3 groups. The corneal astigmatism after 2 weeks in group A (1.71 +/- 1.47D) was higher than that before operation (1.28 +/- 1.05D, P = 0.126). With 12 months gone, the astigmatism almost returned to preoperative levels. The corneal astigmatisms after 2 weeks in group B and C (1.99 +/- 1.20D and 2. 22 +/- 1.39D) were significantly higher than those before operation (1.20 +/- 0.85D and 1.18 +/- 0.93D, P = 0.002, P = 0.001), respectively. With 12 months gone, the mean astigmatisms in group B and C (1.87 +/- 0.91D and 1.90 +/- 1.16D) were still significantly higher than those before operation (P = 0.001, P = 0.003). The highest astigmatic polar values in group A, B, and C (1.00D, 1. 89D, and 1. 77D) occurred after 2 weeks, 1 month, and 1 month postoperation, respectively, which were significantly higher than those before operation (0.19 +/- 1.32D, 0.12 +/- 1.22D, and 0.17 +/- 1.25D, P < 0.01), respectively. With 12 months gone, they were 0. 03D, -0. 18D, and -0. 13D higher than those before operation, respectively. The rates of function bleb and thin-wall bleb were 71.43% and 26.37% in group A, 75.38% and 29.23% in group B, 72.09% and 25.58% in group C, respectively at 12 months after treatment There were no significant differences among the 3 groups.

CONCLUSION"Straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with MMC can reduce complications and get satisfactory results in reducing IOP and SIA.

Aged ; Astigmatism ; etiology ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Postoperative Complications ; Sclera ; surgery ; Surgical Flaps ; Suture Techniques ; Trabeculectomy ; adverse effects ; methods

PURPOSE: To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. METHODS: A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. RESULTS: The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38). CONCLUSIONS: There was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.
Child, Preschool ; Female ; Follow-Up Studies ; Glaucoma/congenital/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; Infant ; Intraocular Pressure/*physiology ; Male ; Mitomycin/*adverse effects ; Nucleic Acid Synthesis Inhibitors/adverse effects ; Reoperation ; Retrospective Studies ; Time Factors ; Trabeculectomy/*adverse effects/*methods ; Treatment Failure ; Treatment Outcome ; *Visual Acuity