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Abstract #3659 Published in IGR 4-2
A randomised, prospective study comparing trabeculectomy augmented with antimetabolites with a viscocanalostomy technique for the management of open angle glaucoma uncontrolled by medical therapy
O'Brart DPS; Rowlands E; Islam N; Noury AMSBritish Journal of Ophthalmology 2002; 86: 748-754
AIMS: To compare trabeculectomy with viscocanalostomy for the control of intraocular pressure (IOP) in open angle glaucoma (OAG) uncontrolled by medical therapy. METHODS: Forty-eight patients (50 eyes) with uncontrolled OAG were randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique (25 eyes). Preoperatively, eyes were graded in terms of risk factors for drainage failure. Those undergoing trabeculectomy were given intraoperative antimetabolites (5-fluorouracil 25 mg/ml (5-FU), mitomycin C (MMC) 0.2 and 0.4 mg/ml) according to a standard protocol. Antimetabolites were not used intraoperatively in eyes undergoing viscocanalostomy, but they were randomized to the use of viscoelastic (Healonid GV) for intraoperative intracanalicular injection. RESULTS: There were no significant differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure, and preoperative IOP. Mean follow up was 19 months (range, 6-24 months). It was 12 months or longer in all eyes, except for one lost to follow-up at six months. At 12 months, complete success (IOP < 21 mmHg without antiglaucoma medications) was seen in all eyes undergoing trabeculectomy (100%), but in only 64% of eyes undergoing viscocanalostomy (p < 0.001). The mean IOP was lower at 12 months (p < 0.001) with trabeculectomy and the number of eyes with IOPs of 15 mmHg or less was greater (p < 0.05). The mean IOP at 12 months was lower in eyes that had undergone viscocanalostomy using intraoperative intracanalicular Healonid GV injection compared to those in which only balanced saline solution had been used (p < 0.01). However, in terms of complete success there was no difference between the viscocanalostomy groups (p < 0.1). With the exception of measurements at one week, visual recovery (logMAR acuity) was similar and laser flare and cell values showed little differences between the groups. Corneal topography and keratometry at 12 months were little different from preoperative values. Postoperative interventions (subconjunctival 5-FU and needling procedures) were similar between the groups. Transient complications such as early bleb leak and hyphema were more common in the trabeculectomy group (p < 0.05). Postoperative cataract formation was more common after trabeculectomy (p < 0.05). CONCLUSIONS: IOP control appears to be better with trabeculectomy. Viscocanalostomy is associated with fewer postoperative complications, although significant complications permanently impairing vision did not occur with either technique.
Dr. D.P.S. O'Brart, Department of Ophthalmology, St Thomas's Hospital, London SE1 7EH, UK. DavidO'Brart@aol.com
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
