[The progression of primary operated glaucoma]

Study of the causes responsible for glaucoma progression in patients operated for glaucoma.

A series of 185 patients operated for primary open angle glaucoma were followed up for a mean period of 3.2 years. 46 patients had evidence of glaucoma progression: insufficient filtration was recognized as the cause in 23 patients, while blockage of the filtering bleb was responsible for the rest of 23 cases.

Progression of glaucoma was detected in 19.32% of patients with functional filtering bleb; 44.1% of patients with intraocular pressure between 16 and 21 mmHg did not show disease progression; 8 out of 23 patients needed a new trabeculectomy; internal obstruction of the bleb was demonstrated in 8 cases; 4 patients needed additional medical therapy; internal revision of the bleb (3 cases) and a new trabeculectomy gave the best results; external obstruction of the bleb was found in 15 patients; 7 had a diffuse fibrovascular proliferation and 8 had an encapsulated bleb. We used a new trabeculectomy for diffuse fibrovascular proliferation and a cystotomy or a cystectomy for encapsulated bleb. The results were good in almost all cases.

Glaucoma progression appears even with postoperative intraocular pressures within statistical normality; identification of the causes responsible for glaucoma progression insures individualized treatment with constant good results.