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Abstract #19158 Published in IGR 3-1
Improving glaucoma surgery
Papadopoulos M; Khaw PTEye 2001; 15: 131-132
This is the third editorial within a period of four months dealing with non-perforating filtering surgery and the improvement of glaucoma in filtering surgery in general. It starts with the statement that there is increasing recognition that intraocular pressure (IOP) in the low teens is required to prevent or minimize glaucoma progression. Therefore, the degree of long-term IOP control by means of a new technique should be the primary measure by which it is judged. Furthermore, this must be shown in a prospective randomized controlled trial. It has become clear that the short-term gain of lower complication rates seen in non-penetrating filtering procedures is at the expense of long-term intraocular pressure control. This editorial refers to a paper by Giselita which showed that trabeculectomy is associated with a 36% reduction of IOP, as opposed to 25% in non-penetrating surgery. The survival analysis is 93% for trabeclectomies and 45% for non-penetrating surgery. Yes, trabeculectomy does seem to be associated with more complications, including a greater need for subsequent cataract surgery. The authors also describe their own preference for improving the outcome of filtering surgery which is related to bleb morphology. As far as the complications are concerned, the authors see three options: develop techniques that manage the complications; attempt to prevent them by modifying the technique; and/or develop a safer operation that does not sacrifice efficacy. Already in 1972 Watson stated that, 'if one procedure replaces another, it must be significantly better than its predecessor'.
Dr M. Papadopoulos, Glaucoma Unit and Wound Healing Research Unit, Moorfields Eye Hospital and Institute of Ophthalmology, London, UK
Classification:
12.1 General management, indication (Part of: 12 Surgical treatment)
