Elsevier

Ophthalmology

Volume 107, Issue 7, July 2000, Pages 1298-1302
Ophthalmology

Trabeculectomy for acute primary angle closure

Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, May 1999, Fort Lauderdale, Florida.
https://doi.org/10.1016/S0161-6420(00)00137-8Get rights and content

Abstract

Objective

To analyze the results of trabeculectomy performed for all cases of acute primary angle closure (APAC).

Design

Retrospective, noncomparative case series

Participants

Fifty-six consecutive patients who underwent trabeculectomy for APAC at two Singapore centers from 1993 through 1995.

Methods

The conventional treatment for APAC is to lower intraocular pressure (IOP) medically, after which laser peripheral iridotomy (PI) is performed. However, in Asian eyes, the acute attack is often refractory to standard treatment. Trabeculectomy is occasionally performed on eyes that do not respond to medical therapy, as well as eyes with APAC that respond to medical therapy but are assessed as having underlying chronic angle-closure glaucoma. In such cases, laser PI is not performed before trabeculectomy.

Main outcome measures

The surgical outcome was assessed in terms of final IOP and the incidence of complications. Success was defined as final IOP less than 21 mmHg without medication, and qualified success was defined as final IOP less than 21 mmHg with medication. Patients whose IOP was more than 21 mmHg, required further glaucoma surgery, lost light perception, or whose eye became phthisical were classified as failures.

Results

The mean follow up was 22 months (range, 6–42 months). In group A, the medical failure group (n = 32), success in IOP control was obtained in 18 patients (56.2%), qualified success was achieved in 3 patients (9.4%), and failure resulted in 11 patients (34.4%). Ten patients (31.3%) encountered early postoperative complications such as shallow anterior chamber. In group B, the medical success group (n = 24), success in IOP control was achieved in 21 patients (87.5%), qualified success was achieved in 3 patients (12.5%), and there were no cases of failure. The incidence of postoperative complications was low (4 eyes [16.7%]). In terms of IOP outcome, trabeculectomy outcome was significantly worse in group A (P < 0.001, Fisher’s exact test).

Conclusions

Because there is a high risk of surgical failure and complications, trabeculectomy may not be the procedure of choice in medically unresponsive cases of APAC.

Section snippets

Patients and methods

A retrospective review was carried out on consecutive patients who underwent trabeculectomy for APAC at two tertiary referral hospitals in Singapore from 1993 through 1995 and who were observed for at least 6 months. Institutional Review Board approval was not required for this particular study because it was retrospective. There was a total of 56 eyes in 56 patients. The demographic characteristics are summarized in Table 1.

The following criteria were used to define cases of APAC.

  • 1.

    Presence of

Results

There were 56 eyes that underwent trabeculectomy for APAC. No patient had antimetabolite therapy. The mean followup period was 22 ± 10.7 months (range, 6–42 months).

The indication for trabeculectomy was as follows:

  • Group A (n = 32 eyes): Medical failure group.

  • Group B (n = 24 eyes): Medical success group but with signs of chronic angle-closure glaucoma. These were eyes with acute angle closure that responded to medication, and IOP decreased to less than 22 mmHg. However, the patients underwent

Discussion

Acute primary angle closure that is resistant to medical therapy is a serious therapeutic challenge in ophthalmology. There is an urgent need to relieve the acute pupillary block to minimize optic nerve damage, and this can be accomplished by laser or surgery. We have found that the success rate (in terms of IOP control) for trabeculectomy performed as an urgent surgical intervention in such medically uncontrolled APAC eyes (group A) was low, at only 56.2%. The incidence of postoperative

References (41)

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The authors have no commercial interest in any of the material discussed in the paper.

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