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Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177
Dirk Marquardt1, Wolfgang E Lieb2, Franz Grehn2
1Department of Ophthalmology, University Hospitals, Josef-Schneider-Strasse 11, 97080 , Würzburg, Germany. info@drmarquardt.com.
Purpose:
To evaluate the long-term outcome of trabeculectomy under the conditions of intensified postoperative care (IPC) compared with conventional follow-up.
Methods:
One hundred and seventy-seven consecutive primary trabeculectomies (168 patients) with a median follow-up of 4.5 years were retrospectively analyzed at the University Eye Hospital, Würzburg. Seventy-three trabeculectomies (70 patients) were followed by the surgeon under the conditions of IPC (group 1), and 104 trabeculectomies (98 patients) were followed by other ophthalmologists without IPC (group 2). The following measures to control wound healing were predominantly used in group 1: (1) increase in topical steroid administration if corkscrew vessels were present; (2) repeated injections of 5-fluorouracil (5-FU) at the beginning of bleb scarring; and/or (3) needling plus 5-FU administration if an encapsulated bleb developed. Postoperative intraocular pressure (IOP) was defined as "successful" when it did not exceed 21 mmHg and was at least 20% lower than the treated preoperative IOP. Stable visual acuity was defined as +/-1 line.
Results:
The success rates of IOP control were about 95% in both groups. In the IPC group 45 of 73 eyes fulfilled all success criteria without additional anti-glaucoma medication (61.6%), whereas in conventional follow-up only 33 of 104 eyes fulfilled all success criteria without medication (31.7%).
Conclusions:
This study demonstrates that a much higher proportion of filtering blebs reach target IOP without medication if measures of IPC are consistently used by a glaucoma specialist when necessary.