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Abstract #10854 Published in IGR 6-2
Filtering glaucoma surgery as outpatient procedure
Sturmer J; Meier F; Sarra GMKlinische Monatsblätter für Augenheilkunde 2004; 221: 334-8
BACKGROUND: While cataract surgery is nowadays performed routinely as an outpatient procedure, performing filtering glaucoma surgery under these conditions remains questionable due to the more demanding perioperative management. PATIENTS AND METHODS: Outpatient filtering glaucoma surgery (trabeculectomy and combined phakoemulsification and trabeculectomy (phakotrab)) is performed at the Ophthalmology Department of Kantonsspital Winterthur when requested by the patient. This paper provides a retrospective review of all outpatient filtering glaucoma procedures performed in the last three and a half years. RESULTS: Forty-six filtering procedures (21 trabeculectomies and 25 phakotrabs) were performed in 45 eyes of 40 patients (50 - 84 years) as outpatient procedures. Mitomycin C was administered in 16/21 trabeculectomies and in 7/25 combined procedures. In the trabeculectomy group, intraocular pressure (IOP) was surgically lowered from 23.3 ± 7.2 mmHg (under 2.4 ± 0.8 IOP-lowering medications) to 12.7 ± 3.5 mmHg (20/21 patients without medication). In the combined group, IOP was lowered from 20.8 ± 6.3 (under 2.0 ± 0.7 medications) to 13.7 ± 2.7 mmHg (only 5/25 patients still requiring IOP-lowering medications). In the latter group, the best corrected visual acuity was below 20/40 only in 2 eyes due to advanced glaucomatous optic atrophy. One patient developed relative intraocular hypotony (IOP 6 mmHg), one patient required needling + 5-fluorouracil injection and one patient required surgical revision of the trabeculectomy after 14 months. DISCUSSION: Adequate patient selection and refined surgical technique (tight wound closure and releasable sutures or argon laser suturolysis) allow performing filtering glaucoma surgery as an outpatient procedure. Extended post-operative care during the first 2 months is the key for IOP-lowering success. LA: German
Augenklinik Kantonsspital Winterthur, Schweiz. joerg@stuermer@ksw.ch
Classification:
12.1 General management, indication (Part of: 12 Surgical treatment)
