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Impressum
Trabeculectomy: Comparison between Intensified Postoperative Care (IPC) and Conventional Follow-up. A retrospective long term analysis of 177 operations.
Marquardt D., Grehn F.
University Eye Hospital Wuerzburg, Germany
Objective: To evaluate the usefulness of intensified postoperative
care (IPC) conventional follow-up in trabeculectomies without using intraoperative
antimetabolites.
Methods: One hundred and eighty-four trabeculectomies (174 patients)
were performed between August 1995 and December 1996. Of these, 177 trabeculectomies
with a follow-up of 4,5 years (median) were retrospectively analyzed.
73 trabeculectomies (70 patients) were followed by the surgeon under the
conditions of IPC (group 1), and 104 trabeculectomies (98 patients) were
followed by other ophthalmologists without IPC (group 2). The following
measures to control wound healing were predominantly used in group 1:
(1) Increase in topical steroid application if cork screw vessels were
present, (2) Repeated injections of 5-Fluorouracil (5-FU) in beginning
bleb scarsing, and/or (3) Needling plus 5-FU application if an encapsulated
bleb developed. Postoperative IOP was defined as "successful"
when not exceeding 21 mmHg and reduced by at least 20% of the treated
praeoperative IOP.
Results: The mean praeoperative IOP of all 177 eyes was 25.7 +/-
4.3 mmHg. The mean postoperative IOP at the last 3 visits was 15.3 +/-
3.3 mmHg. 167 of 177 eyes fulfilled the IOP success criteria without or
with medication (94.4%). 69 of 73 eyes (94.5%) of group 1 versus 99 of
104 (95.2%) of group 2 fulfilled the above mentioned IOP success criteria
without or with medication. 61 of 69 eyes (83.6%) of group 1 and 77 of
99 (74.0%) of group 2 had stable visual fields (Aulhorn criteria) and
stable visual acuity (+/- 1 line). In group 1, 44 of 73 eyes fulfilled
all success criteria without medication (60.4%). In group 2, however,
only 33 of 104 eyes fulfilled all success criteria without medication
(31.7%).
Conclusion: This study demonstrates that a much higher percentage
of filtering blebs reach target IOP without medication if measures of
intensified postoperative care are generally used when necessary.