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International Ophthalmology

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01-05-2020 | Glaucoma | Original Paper

Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?

Authors: Ramanjit Sihota, Jyoti Shakrawal, Talvir Sidhu, Ajay K. Sharma, Tanuj Dada, Veena Pandey

Published in: International Ophthalmology | Issue 5/2020

Abstract

Purpose

Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy.

Methods

In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP ≤ 12 mmHg, B: IOP ≤ 15 mmHg and C: IOP ≤ 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge!

Results

The mean age of patients was 46.32 ± 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of ≤ 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 ± 16.80% at last review and was 59.47 ± 16.07% in PACG, 62.40 ± 17.72% in POAG, 71.89 ± 8.50% in JOAG and 67.74 ± 18.10% in secondary glaucoma eyes. “Target” IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes.

Conclusion

Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.

Khaw PT, Chiang M, Shah P, Sii F, Lockwood A, Khalili A et al (2012) Enhanced trabeculectomy—the Moorfields safer surgery system. Dev Ophthalmol 50:1–28PubMedCrossRef

Yu-Wai-Man C, Khaw PT et al (2015) Developing novel anti-fibrotic therapeutics to modulate post-surgical wound healing in glaucoma: big potential for small molecules. Expert Rev Ophthalmol. 10(1):65–76PubMedCrossRef

Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA et al (2001) Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 108(11):1943–1953PubMedCrossRef

Ederer F, Gaasterland DA, Dally LG, Kim J, VanVeldhuisen PC, Blackwell B et al (2004) The advanced glaucoma intervention study (AGIS). Comparison of treatment outcomes within race: 10-year results. Ophthalmology 111(4):651–664PubMedCrossRef

Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL et al (2012) Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 153(5):789–803PubMedPubMedCentralCrossRef

Bevin TH, Molteno AC, Herbison P et al (2008) Otago glaucoma surgery outcome study: long-term results of 841 trabeculectomies. Clin Exp Ophthalmol 36(8):731–737PubMedCrossRef

Molteno ACB, Bosma NJ, Kittelson JM et al (1999) Long-term results of trabeculectomy—1976 to 1995. Ophthalmology 106:1742–1750PubMedCrossRef

Landers J, Martin K, Sarkies N, Bourne R, Watson P et al (2012) A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology 119(4):694–702PubMedCrossRef

Shaarawy TM, Sherwood MB, Grehn F (2009) WGA guidelines on design and reporting of glaucoma surgical trials, 93:17

10.

Hodapp E, Parrish RK II, Anderson DR (1993) Clinical decisions in glaucoma. C. V. Mosby, St. Louis, pp 52–61

11.

Damji KF, Behki R, Wang L et al (2003) Canadian perspectives in glaucoma management: setting target intraocular pressure range. Can J Ophthalmol 38(3):189–197PubMedCrossRef

12.

Romero P, Hirunpatravong P, Alizadeh R, Kim E-A, Nouri-Mahdavi K, Morales E et al (2017) Trabeculectomy with mitomycin-C. J Glaucoma 27(2):1

13.

Beckers HJM, Kinders KC, Webers CAB et al (2003) Five-year results of trabeculectomy with mitomycin C. Graefe’s Arch Clin Exp Ophthalmol 241(2):106–110CrossRef

14.

Cillino S, Casuccio A, Di Pace F, Cagini C, Ferraro LL, Cillino G et al (2016) Biodegradable collagen matrix implant versus mitomycin-C in trabeculectomy: five-year follow-up. BMC Ophthalmol 16(4):24PubMedPubMedCentralCrossRef

15.

Pathania D, Senthil S, Rao HL, Mandal AK, Garudadari CS et al (2014) Outcomes of trabeculectomy in juvenile open angle glaucoma. Indian J Ophthalmol 62(2):224–228PubMedPubMedCentralCrossRef

16.

Law SK, Modjtahedi SP, Mansury A, Caprioli J et al (2007) Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison. Eye 21(1):71–78PubMedCrossRef

17.

Tsai H-Y, Liu CJ, Cheng C-Y et al (2009) Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma. Br J Ophthalmol 93(7):943–948PubMedCrossRef

18.

Kirwan JF, Lockwood AJ, Shah P, Macleod A, Broadway DC, King AJ et al (2013) Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology 120(12):2532–2539PubMedCrossRef

19.

Gupta V, Ov M, Rao A, Sharma A, Sihota R et al (2012) Long-term structural and functional outcomes of therapy in juvenile-onset primary open-angle glaucoma: a five-year follow-up. Ophthalmologica 228(1):19–25PubMedCrossRef

20.

Tsai J-C, Chang H-W, Kao C-N, Lai I-C, Teng M-C et al (2003) Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma. Ophthalmologica 217(1):24–30PubMedCrossRef

21.

Jacobi PC, Dietlein TS, Krieglstein GK et al (1999) Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome. Ophthalmic Surg Lasers 30(8):637–646PubMed

22.

Chen CW, Huang HT, Bair JS, Lee CC et al (1990) Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol 6(3):175–182PubMedCrossRef

23.

Mermoud A, Salmon JF, Murray AD et al (1993) Trabeculectomy with mitomycin C for refractory glaucoma in blacks. Am J Ophthalmol 116(1):72–78PubMedCrossRef

24.

Kitazawa Y, Yamamoto T, Sawada A, Hagiwara Y et al (1996) Surgery for refractory glaucoma. Aust N Z J Ophthalmol 24(4):327–332PubMedCrossRef

25.

Sihota R, Angmo D, Ramaswamy D, Dada T et al (2018) Simplifying "target" intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian J Ophthalmol 66(2):495–505PubMedPubMedCentralCrossRef

26.

Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK, CIGTS Study Investigators (2009) Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors. Ophthalmology 116(2):200–207PubMedCrossRef

27.

Musch DC, Gillespie BW, Niziol LM, Lichter PR, Varma R, CIGTS Study Group for the CS (2011) Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 118(9):1766–1773CrossRef

28.

Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE et al (2005) Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol 140(1):16–22PubMedCrossRef

29.

Olayanju JA, Hassan MB, Hodge DO, Khanna CL et al (2015) Trabeculectomy-related complications in Olmsted County, Minnesota, 1985 through 2010. JAMA Ophthalmol 133(5):574PubMedPubMedCentralCrossRef

30.

Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y et al (2016) Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol. 94(7):561–570CrossRef

31.

AGIS (Advanced Glaucoma Intervention Study) Investigators (2001) The advanced glaucoma intervention study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol 119(12):1771–1779CrossRef

32.

Sihota R, Angmo D, Sen S, Gupta V, Dada T, Pandey RM et al (2016) The long-term outcome of primary “bleb-sparing, epithelial exchange” in dysfunctional filtering blebs. J Glaucoma 25(7):571–578PubMedCrossRef

Title: Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?
Authors: Ramanjit Sihota
Jyoti Shakrawal
Talvir Sidhu
Ajay K. Sharma
Tanuj Dada
Veena Pandey
Publication date: 01-05-2020
Publisher: Springer Netherlands
Keywords: Glaucoma
Trabeculectomy
Cataract
Published in: International Ophthalmology / Issue 5/2020
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-020-01289-5

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Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?

Abstract

Purpose

Methods

Results

Conclusion

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Abstract

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