Published in:
01-01-2019 | Original Paper
Role of trabeculectomy in advanced glaucoma: Whether we stand to consider it a bane or a boon today?
Published in: International Ophthalmology | Issue 1/2019
Login to get accessAbstract
Purpose
To elucidate the role of trabeculectomy in advanced glaucoma.
Materials and methods
Only patients with primary open-angle glaucoma were selected. All patients who had cup–disc ratio of 0.9 or a near-total cupping were given a trial of aggressive maximum medical therapy for IOP control for at least 4 weeks. Target IOP was defined as ≤ 12 mm Hg. Patients who showed progression were included in the study. A total of 10 patients were selected. Trabeculectomy was performed using limbal-based conjunctival flap. Patients were followed up for a period of 2 years for visual acuity, intraocular pressure, visual fields, slit-lamp biomicroscopy and bleb morphology.
Results
Mean preoperative intraocular pressure on five drugs was 21.7 ± 3.8 mm Hg (range 18–27 mm Hg) on maximum medical therapy. Mean post-operative intraocular pressure was 11 ± 1.78 mm Hg (range 9–13 mm Hg) and 11 ± 1.92 mm Hg (range 9–14 mm Hg) at 1 month and 6 months post-operatively, respectively. Post-operatively, the visual acuity remained stable in 17 patients. It dropped by 1 Snellen line in 2 patients and 2 Snellen lines in 1 patient, respectively, over a period of 6 months and later improved to 6/6P following cataract surgery. There was no defined visual field progression in any of the 20 patients.
Conclusion
Besides being a cost-effective alternative to medical management, trabeculectomy not only provides a better IOP control but also has a high safety profile when performed by an experienced surgeon.