The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management.
OBJECTIVE
To evaluate prospectively 3 different approaches to the management of a flat anterior chamber (FAC) because of overfiltration in the early postoperative period after trabeculectomy.


METHODS
Thirty-six eyes diagnosed with a FAC with total iridocorneal touch, but no lenticular touch (grade II) because of overfiltration in the first 14 days after trabeculectomy were randomized prospectively into 3 groups: group 1--anterior chamber reformation with viscoelastic substance; group 2--anterior chamber reformation with balanced salt solution and concurrent drainage of choroidal effusion; and group 3--pharmacologic therapy with atropine, phenylephrine, and in select cases oral acetazolamide. Outcome measures were visual acuity, amount of intraocular pressure (IOP) reduction, and achievement of predetermined target IOP.


RESULTS
Treatment group 2 had a greater number of eyes with acuity decline of two or more lines relative to group 3 (P=0.04). Group 1 had more eyes with acuity decline of two or more lines relative to group 3, but this was not significant (P>0.05).


CONCLUSIONS
For grade II FACs because of overfiltration in the early postoperative period after trabeculectomy, reformation of the anterior chamber with drainage of choroidal effusion may be associated with greater long-term trabeculectomy success, but is associated with greater visual acuity loss relative to medicinal therapy alone. Reformation with viscoelastic resulted in a trend toward lowest final IOP in comparison to medicinal therapy alone.
de Barros
Daniela S Monteiro
DS
William and Anna Goldberg Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, PA 19107, USA.
Navarro
Julia B V Kuntz
JB
Mantravadi
Anand V
AV
Siam
Ghada A
GA
Gheith
Moataz E
ME
Tittler
Ethan H
EH
Baez
Karin A
KA
Martinez
Silvana M
SM
Spaeth
George L
GL
D000085:Acetates / Q000008:administration & dosage; D000086:Acetazolamide / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology / Q000601:surgery*; D001285:Atropine / Q000008:administration & dosage; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000145:classification / Q000209:etiology / Q000628:therapy*; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage; D009184:Mydriatics / Q000008:administration & dosage; D010656:Phenylephrine / Q000008:administration & dosage; D011183:Postoperative Complications; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D014130:Trabeculectomy; D055682:Viscoelastic Substances / Q000008:administration & dosage; D014792:Visual Acuity / Q000502:physiology
D000085:Acetates; C030660:BSS solution; D002257:Carbonic Anhydrase Inhibitors; D004338:Drug Combinations; D008903:Minerals; D009184:Mydriatics; D055682:Viscoelastic Substances; D010656:Phenylephrine; D012965:Sodium Chloride; D001285:Atropine; D000086:Acetazolamide