Related Experiment Videos
Risk factors for failures of trabeculectomies performed without antimetabolites
H Mietz1, B Raschka, G K Krieglstein
1Department of Ophthalmology, University of Cologne, Cologne, Germany.
Aims:
To assess the risk profile for the failure of trabeculectomies in a large group of patients who were selected to be operated on without the use of antimetabolites. This was done in an effort to find subgroups of patients who may not need antimetabolites for primary procedures.
Methods:
Consecutive patients scheduled for routine trabeculectomies were operated during a 4 year period and were followed up for at least 6 months postoperatively. Patients were regularly examined in the glaucoma unit and by their local ophthalmologists. Pre- and postoperative data were evaluated and success rates determined.
Results:
709 eyes of 566 patients were operated on; 534 eyes of 534 patients (94.4%) were finally evaluated. The mean follow up was 27.9 (SD 13.6) months with a range of 6-62 months. Success rates for complete surgical success ranged from 59% in the best group with pigmentary dispersion syndrome to 0% in the worst group with neovascular glaucoma. Success rates of patients with POAG, pseudoexfoliation, chronic angle closure, pigmentary dispersion syndrome, and dysgenetic glaucoma were similar. Failure rates ranged from 11% in the best group (pseudoexfoliation) to 80% in the worst group (neovascular glaucoma). Failure rates were high in complicated forms of glaucoma such as traumatic (30%), buphthalmus (40%), and uveitic (50%). For repeat trabeculectomies, the failure rate was 49% (20 of 41 eyes). The mean time until failure ranged from 2.7 months (traumatic) to 15.5 months (pigmentary dispersion syndrome) and was 4.9 months for repeat trabeculectomies.
Conclusion:
Trabeculectomy performed in selected groups of patients has a favourable outcome without the use of antimetabolites. It may be possible to avoid antimetabolites in these groups of patients for primary procedures.
Insights
Trabeculectomy without antimetabolites shows favorable outcomes in selected glaucoma patients. This approach may allow avoiding antimetabolites in primary procedures for specific patient subgroups.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Outcomes
Background:
- Trabeculectomy is a common glaucoma surgery.
- Antimetabolites are often used to improve success rates.
- Identifying patients who do not require antimetabolites is clinically significant.
Purpose of the Study:
- To evaluate the risk of trabeculectomy failure in patients not using antimetabolites.
- To identify patient subgroups who may not need antimetabolites for primary glaucoma surgery.
Main Methods:
- A consecutive series of patients undergoing trabeculectomy without antimetabolites were followed for at least 6 months.
- Pre- and postoperative data were collected and analyzed.
- Success and failure rates were determined for different glaucoma types.
Main Results:
- Success rates varied widely, from 59% in pigmentary dispersion syndrome to 0% in neovascular glaucoma.
- Failure rates ranged from 11% in pseudoexfoliation to 80% in neovascular glaucoma.
- Repeat trabeculectomies had a high failure rate (49%).
Conclusions:
- Trabeculectomy can achieve favorable outcomes without antimetabolites in carefully selected glaucoma patients.
- Antimetabolite use may be avoidable in primary procedures for certain patient groups.