Early postoperative trabeculectomy leakage: incidence, time course, severity, and impact on surgical outcome

To establish the incidence, time course, and severity of conjunctival wound leakage following trabeculectomy, and also to establish whether early wound leakage adversely affects the ultimate outcome of the surgery.

A prospective, observational case series of sequential trabeculectomies performed in a single institution over a 12 month period. Datasets on 286 operations were analysed. A fornix based conjunctival flap was used in 254 cases and a limbus based conjunctival flap in 41 cases. At every postoperative visit trabeculectomies were assessed for four grades of leakage (none; mild; moderate; severe), and for success or failure at the 6 month follow up post surgery. Pressure was applied to the trabeculectomy bleb to record the maximum rates of leakage and improve kappa statistics. Study clinicians were validated with respect to their scoring of leaks before starting the study.

169 of the 286 trabeculectomies (59%) showed leakage at some stage postoperatively. 159 of 245 fornix based flaps (65%) leaked compared with 10 of 41 limbus based flaps (24%). Median time to leak was 3.5 (range 0-408) days. Median duration of leakage was 14 (range 2-457) days. 14 (5%) of trabeculectomies failed completely. A further 40 (14%) were a partial failure. In total, 23 of 117 (20%) without postoperative leaks partially or completely failed compared with 31 of 169 (18%) with leaks. Cross tabulation of partial and complete failure by leak shows no evidence of an adverse effect of leaking on the outcome (chi(2) = 1.81, p = 0.4).

There is no evidence to support the hypothesis that early postoperative leakage of fornix based conjunctival flaps affects the outcome of trabeculectomy.