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Abstract #6536 Published in IGR 3-2
Postoperative complications and therapeutic consequences after trabeculectomy
Picht G; Mutsch Y; Grehn FOphthalmologe 2001; 98: 629-634
BACKGROUND: Intensive follow-up after trabeculectomy is important for long-term success. In the postoperative period, complications must be detected early in order to initiate adequate therapeutic measures. PATIENTS AND METHODS: In a retrospective study 113 eyes from 113 consecutive patients were followed-up for a period of six months after trabeculectomy with regard to postoperative complications and therapeutic decisions (invasive and conservative). Criteria of success were defined as an intraocular pressure (IOP) < 21 mmHg without antiglaucomatous treatment as well as an IOP reduction >20% compared to the preoperatively treated IOP. RESULTS: Most of the postoperative complications occurred within the first three weeks: scarring of the filtering bleb (47.6%), choroidal detachment (18.6%), shallowing of the anterior chamber (8%), fibrinous reaction (5.3%), overfiltration (4.4%), reduced flow under the scleral flap (4.4%), corneal dellen (3.5%), prolapse of the iris (3.5%), external fistulation (2.7%), increase of the IOP due to steroids (1.8%), detachment of the ciliary body (1.8%) and malignant glaucoma (0.9%). In the postoperative period, 45.1% of the eyes needed further interventions such as 5-fluorouracil (5-FU) injections (28. 3%), needling and 5-FU-injections (14.2%), laser suturolysis (6.2%). Repositioning of the iris, YAG laser iridotomy, laser treatment of the filtering bleb, autologous blood injection and cyclocryoapplication were needed only in rare cases and 36.3% received other conservative treatment (i.e., modification of topical steroids, increase of cycloplegic treatment). After 6 months the success rate without antiglaucoma medication was 88.5%. CONCLUSIONS: An intensive follow-up after trabeculectomy is mandatory to avoid postoperative failure. In about half the patients, postoperative additional therapeutic measures became necessary, particularly if scarring of the filtering bleb occurred. Paying attention to these factors yields in a high success rate after filtering surgery. LA: German
Dr. F. Grehn, Universitäts-Augenklinik Würzburg, Joseph-Schneider-Strasse 11, 97080 Würzburg, Germany. f.grehn@augenklinik.uni-wuerzburg.de
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
