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Abstract #18276 Published in IGR 3-3
Prognosis and risk factors for early postoperative wound leaks after trabeculectomy with and without 5-fluorouracil
Parrish RK II; Schiffman JC; Feuer WJ; Heuer DK; The Fluorouracil Filtering Surgery Study GroupAmerican Journal of Ophthalmology 2001; 132: 633-640
PURPOSE: To evaluate the prognosis of patients who develop early postoperative wound leaks after trabeculectomy, to determine risk factors for these leaks, and to document adverse outcomes. DESIGN: Multicenter, randomized, clinical trial. METHODS: Two hundred and thirteen patients with previous cataract surgery or failed filtering surgery were randomized to either trabeculectomy (standard group) or trabeculectomy with postoperative subconjunctival 5-fluorouracil injections (5-FU group). Masked measurements of intraocular pressure (IOP) were performed throughout five years of follow-up. Failure was defined as a reoperation to control IOP or an IOP greater than 21 mmHg with or without medication at or after the one-year examination. An early postoperative wound leak was defined as one that developed within two weeks postoperatively, determined by daily topical fluorescein testing. RESULTS: At one year (five years), the success rate for the 5-FU group was 80% (54%) in eyes without a leak, and 60% (28%) in those with a leak. The one-year (five-year) success rate in the standard group was 50% (24%) in those without a leak and 44% (15%) in those with a leak (p = 0.018, long-rank test, adjusted for treatment). Leaks were more common in the 5-FU group, 34/105 (32%), than in the standard treatment group, 22/108 (20%; p = 0.66, Χ2). More eyes with one-layer conjunctiva-Tenon capsule closure developed leaks 40/115 (35%) than those with two-layer closure 16/95 (17%; p = 0.006, Χ2). More eyes with a trabeculectomy located inferiorly 29/76 (38%) developed leaks than those done superiorly 27/137 (20%; p = 0.006, Χ2). Patients with leaks were older (66 years) than those without leaks (60 years; p = 0.011, t test). CONCLUSIONS: An early postoperative wound leak was a risk factor for trabeculectomy failure. The authors recommend that trabeculectomy be performed in a superior location with a two-layer closure.
Dr J.C. Schiffman, Bascom Palmer Eye Institute, University of Miami School of Medicine, 1638 NW 10th Avenue, Miami, FL 33136, USA. jschiffman@miami.edu
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)