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J. R. Zelefsky, R. Ritch, C. Tello, J. M. Liebmann; Early Postoperative Intraocular Pressure as a Predictor for Long-Term Success in Trabeculectomy With Mitomycin-C. Invest. Ophthalmol. Vis. Sci. 2009;50(13):167.
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To determine whether early postoperative intraocular pressure (IOP) after mitomycin-C (MMC) augmented trabeculectomy is correlated with long-term IOP control.
We reviewed the charts of all consecutive patients who underwent trabeculectomy with MMC during a four-year period. Patients with a history of prior intraocular surgery other than uncomplicated cataract extraction were excluded. All patients underwent a fornix-based trabeculectomy with intentional tight suturing of the scleral flap to avoid early postoperative hypotony. Patient demographics and postoperative courses were analyzed and evaluated. IOP measurements taken at postoperative days 1, 7 and 1 month postoperatively were correlated with IOP measurements taken at postop months 6, 9 and one year postoperatively.
One hundred eighty three eyes (92 men, 91 women) were included. The mean age was 67.2 (±13.3) years. Mean preoperative IOP was 23.5 (±9.4) mmHg. The mean IOP on postoperative day #1 was 20.2 (±12.0) mmHg (p=0.05). The mean IOP on postoperative month #1 was 12.8 (±6.5) mmHg (p<0.05). The mean IOP one year postoperatively was 14.4 (±7.9) mmHg (p<0.05).
Elevated IOP after trabeculectomy with MMC in the early postoperative phase does not correlate with long-term IOP control. Intentional tight suturing of the scleral flap can reduce the risk of early post-operative complications such as hypotony. Planned laser suture lysis or removal of releasable sutures effectively lowers IOP in the short term and can successfully maintain a therapeutic IOP one year postoperatively.
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