PURPOSE: To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy. METHODS: An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups. RESULTS: In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group. CONCLUSIONS: The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.
Blister ; Collagen ; Fluorouracil ; Glaucoma ; Humans ; Manometry ; Methods ; Slit Lamp ; Sutures ; Trabeculectomy

PURPOSE: To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye. METHODS: This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ≥20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model. RESULTS: The mean pretreatment IOP was 23.17 ± 6.96 mmHg. The mean IOP reduction was 5.59 ± 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 ± 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively). CONCLUSIONS: SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.
Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Methods ; Proportional Hazards Models ; Retrospective Studies ; Shiga Toxin 1 ; Trabeculectomy

PURPOSE: To compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy. METHODS: Changes in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups. RESULTS: Forty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group (p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group (p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group (p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months (p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months (p = 0.027). CONCLUSIONS: Both the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.
Cell Count ; Endothelium, Corneal/*pathology ; Female ; Follow-Up Studies ; Glaucoma/diagnosis/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Prosthesis Implantation/*methods ; Time Factors ; Trabeculectomy/*methods ; Treatment Outcome

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

PURPOSE: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. METHODS: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. RESULTS: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). CONCLUSIONS: Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Glaucoma/*surgery ; Humans ; Hyaluronic Acid/*therapeutic use ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Tonometry, Ocular ; Trabeculectomy/*methods ; Viscosupplements/*therapeutic use

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

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

Glaucoma ; congenital ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Trabeculectomy ; 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