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Editors Selection IGR 9-4
Surgical treatment: Modifications
Comment by Paul Palmberg on:
12642 Comparison of subscleral partial thickness sclerectomy plus trabeculotomy with trabeculectomy for primary open angle glaucoma, Agarwal HC; Elankumaran P; Gupta V et al., Asian Journal of Ophthalmology, 2005; 7: 96-100
Agarwal et al. (1080) report the results of a randomized trial to compare the efficacy and complications of an operation called 'sub-scleral partial thickness sclerctomy plus trabeculotomy with mitomycin C' with those of trabeculectomy with mitomycin C. Kaplan-Meier survival analysis for achieving an IOP < 21 mmHg without medication at two years was 52% for the new operation and 76% for trabeculectomy with MMC (log-rank test, p = 0.07), an almost significantly worse outcome for the new procedure. The authors reported somewhat fewer complications with the new procedure, especially hyphema and cataract progression, both of which might be attributable to the iridectomy performed with trabeculectomy, and might be avoided by omitting it when circumstances permit. The authors have yet to make a convincing case in favor of the new procedure.
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