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Glauco Almeida, Camila Zangalli, Luciana Alencar, Marcelo Hatanaka, Eduardo Ferreira, George Spaeth; Variability of trabeculectomy among glaucoma surgeons: a survey from different countries. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3508. doi: https://doi.org/.
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To assess and report on preoperative care, postoperative management and intraoperative techniques used for trabeculectomy among glaucoma surgeons from several different countries.
An electronic invitation was mailed to ophthalmologists who were active in glaucoma. Participants were invited to access the website http://www.trabeculectomystudy.com/. This website included information regarding the purpose, confidential nature and length of the survey and researcher’s contact phone number. Only ophthalmologists that reported being active in glaucoma and agreed to complete the survey were included in the analysis. Participants who selected more than one answer per question were excluded from the study. The questionnaire was composed of 60 multiple-choice questions regarding preoperative care, intraoperative technique and postoperative management of patients undergoing primary trabeculectomy. Data were analyzed using frequency tabulations in SPSS (version 20.0).
101 ophthalmologists from several different countries, but mostly from Brazil (72%) responded to this survey. Preoperatively, 54% of respondents reported using steroids while 33% preferred non-steroidal anti-inflammatory agents. 39% used an anti-inflammatory medication for less than 5 days; 61% used for more than 5 days. Local block was the most popular anesthetic technique. The variability of operative technique was marked. For example, 4,95% used no mitomycin at all, 35% (0.2- 0.3 mg/ml) and 35% (0.31 - 0.5 mg/ml). The duration of time of application varied markedly. Some surgeons excise a block of sclera 1 mm x 2 mm in size, others a “snippet” so small it cannot be measured, and yet others excise no sclera at all. One-tenth of the surgeons remove trabecular meshwork, and 9/10ths do not. Postoperatively, 38% of surgeons used atropine. Twenty-eight percent reported never using glaucoma medications in the postoperative period.
This survey demonstrates that the surgical technique and preoperative and postoperative care for trabeculectomy is not standard. These significant variations in practice need to be taken into account when considering the outcomes of trabeculectomy, which presumably will vary depending upon the technique employed.
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