Trabeculectomy in the 21st century: a multicenter analysis.
OBJECTIVE
To evaluate the efficacy and safety of current trabeculectomy surgery in the United Kingdom.


METHODS
Cross-sectional, multicenter, retrospective follow-up.


METHODS
A total of 428 eyes of 395 patients.


METHODS
Consecutive trabeculectomy cases with open-angle glaucoma and no previous incisional glaucoma surgery from 9 glaucoma units were evaluated retrospectively. Follow-up was a minimum of 2 years.


METHODS
Surgical success, intraocular pressure (IOP), visual acuity, complications, and interventions. Success was stratified according to IOP, use of hypotensive medications, bleb needling, and resuturing/revision for hypotony. Reoperation for glaucoma and loss of perception of light were classified as failures.


RESULTS
Antifibrotics were used in 400 cases (93%): mitomycin C (MMC) in 271 (63%), 5-fluorouracil (5-FU) in 129 (30%), and no antifibrotic in 28 (7%). At 2 years, IOP (mean ± standard deviation) was 12.4 ± 4 mmHg, and 342 patients (80%) achieved an IOP ≤ 21 mmHg and 20% reduction of preoperative IOP without IOP-lowering medication, whereas 374 patients (87%) achieved an IOP ≤ 21 mmHg and 20% reduction of preoperative IOP overall. An IOP ≤18 mmHg and 20% reduction of preoperative IOP were achieved by 337 trabeculectomies (78%) without IOP-lowering treatment and by 367 trabeculectomies (86%) including hypotensive medication. Postoperative treatments included suture manipulation in 184 patients (43%), resuturing or revision for hypotony in 30 patients (7%), bleb needling in 71 patients (17%), and cataract extraction in 111 of 363 patients (31%). Subconjunctival 5-FU injection was performed postoperatively in 119 patients (28%). Visual loss of >2 Snellen lines occurred in 24 of 428 patients (5.6%). A total of 31 of the 428 patients (7.2%) had late-onset hypotony (IOP <6 mmHg after 6 months). In 3 of these, visual acuity decreased by >2 Snellen lines. Bleb leaks were observed in 59 cases (14%), 56 (95%) of which occurred within 3 months. Two patients developed blebitis. Bleb-related endophthalmitis developed in 1 patient within 1 month postoperatively and in 1 patient at 3 years. There was an endophthalmitis associated with subsequent cataract surgery.


CONCLUSIONS
This survey shows that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required.
Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, United Kingdom. Electronic address: jfkirwan@mac.com.
James F
JF
Kirwan
National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
Alastair J
AJ
Lockwood
National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom.
Peter
P
Shah
Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
Alex
A
Macleod
Norfolk and Norwich University Hospital & University of East Anglia, Norwich, United Kingdom.
David C
DC
Broadway
Nottingham University Hospital, Queens Medical Centre Campus, Nottingham, United Kingdom.
Anthony J
AJ
King
Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK and Cranfield University, Bedford, United Kingdom.
Andrew I
AI
McNaught
National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
Pavi
P
Agrawal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D019985:Benchmarking; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000639:trends*; D016896:Treatment Outcome; D006113:United Kingdom; D014792:Visual Acuity / Q000502:physiology
D000477:Alkylating Agents; D000959:Antihypertensive Agents