[Analysis of intra-operative and early post-operative complications and safety in non-penetrating trabecular surgery].
OBJECTIVE
To evaluate the safety, effectiveness and complications of non-penetrating trabecular surgery (NPTS). METHODS A total of 168 patients ( 258 eyes) of primary open angle glaucoma were divided into 2 groups randomly, and they were matched according to the age, sex and severity of disease. NPTS with reticulated hyaluronic acid implant was taken in one group, and traditional trabeculectomy was taken in the other. Pre-a2operative mean intraocular pressure (IOP) in the NPTS group and trabeculectomy group was (31.85 +/- 4.83) and (32.59 +/- 4.62) mm Hg (1a(c)mm Hg = 0.133 kPa), respectively. The post-operative IOP and complications in these 2 groups were compared.


RESULTS
(1) IOP: The mean IOP on post-operative 7th, 14th day, 1st, 3rd and 6th month was (6.67 +/- 2.43), (11.42 +/- 2.89), (12.59 +/- 2.24), (15.45 +/- 1.82), and (17.99 +/- 1.80) mm Hg respectively in the NPTS group, while that in the trabeculectomy group for the same time a(c)series was (4.87 +/- 1.65), (10.48 +/- 2.38), (12.01 +/- 2.83), (15.01 +/- 2.66), an.d (17.48 +/- 2.97) mm Hg respectively. Statistically significant differences between these 2 groups were found on the post-operative 7th day and 14th day (t = 7.03, 2.89; P < 0.000 1, P = 0.004). However, significant difference was not noted for pre-operative and other post-operative IOP in the follow-up (t = 1.28, 1.78, 1.55, 1.60; P = 0.202, 0.077, 0.124, 0.112). (2) Visual acuity: There were no statistical differences of visual acuity between the 2 groups (kappa(2) = 0.135, 0.151, 0.024, 0.076; P = 0.935, 0.927, 0.988, 0.963). (3) COMPLICATIONS: I and II degree shallow anterior chamber was encountered in 57 eyes in the NPTS group, while that in the trabeculectomy group was 70. Twelve eyes with III degree shallow anterior chamber were found exclusively in the trabeculectomy group. Ciliary body or choroidal detachment was found in 66 and 70 eyes respectively in the NPTS and trabeculectomy group. Hypotony was encountered in 5 eyes exclusively in the trabeculectomy group. COMPLICATIONS were found to be statistically different in 2 groups (kappa(2) = 9.95, 15.27, 4.60, 6.19; P < 0.05). Hyphema was found in 2 and 6 eyes respectively in the NPTS and trabeculectomy group. Light anterior uveitis was found in 5 and 9 eyes respectively in the NPTS and trabeculectomy group. Vitreous extrusion was experienced in 1 eye of trabeculectomy group. Some complications (16.2%) related to operative skill were also experienced in the NPTS group.


CONCLUSIONS
Over-filtration and surgical injury related complications are significantly reduced in the NPTS group compared to those in the trabeculectomy group. NPTS is safer than traditional trabeculectomy. Mastering surgical skills is required for reducing complications of NPTS.
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China. wningli@21cn.com
Ningli
N
Wang
Heping
H
Wu
Tiancai
T
Ye
Xiuqi
X
Chen
Mingbing
M
Zeng
Zhigang
Z
Fan
D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*