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M. E. Gheith, K. A. Baez, S. Minelli, D. S. Monteiro de Barros, G. A. Siam, E. H. Tittler, G. L. Spaeth; A Randomized, Prospective Study of Three Methods of Management of Flat Anterior Chamber Following Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):840.
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To evaluate three different approaches to the management of post-trabeculectomy "flat anterior chamber" (FAC): 1) reforming the anterior chamber (AC) with viscoelastic substance (sodium hyaluronate); 2) draining the choroidal detachment and reforming the AC in the operating room; and 3) employing medical treatment alone, while waiting for spontaneous reformation of the AC.
36 cases were prospectively randomized into one of the three groups for different forms of management the day after the FAC was diagnosed. Follow-up evaluations were performed at one, two, and four weeks, and between three and twelve month intervals after that. Data gathered included age, race, sex, diagnosis, previous operations, stage of disease, visual outcome (visual acuity), and pre- and post-operative intraocular pressure (IOP).
Loss of visual acuity was 1.1 Snellen lines in Group One, 3.3 lines in Group Two, and 0.5 lines in Group Three, the difference between Groups Two and Three being marginally significant. Cataract development was a major reason for loss of vision. Six eyes redeveloped a FAC, one of them twice. Three of these six eyes (50%), including one in which FAC reoccurred twice, were in Group One (reformation of the AC with viscoelastic substance); the three others (50%) were in group Two and had had drainage and AC reformation performed twice. No case in Group Three (medical therapy alone) redeveloped a FAC. IOP lowering greater than 30% (on no medication) occurred in nine out of 11 eyes (82%) in Group One, six out of 13 eyes (46%) in Group Two, and four out of 12 eyes (33%) in Group Three.
When patients have grade II FAC post-operatively, it is reasonable to use medical therapy alone, waiting for spontaneous reformation, recognizing that such cases will probably not have maximal lowering of IOP. However, if there is any other indication of decreasing filtration, then reformation of the AC with viscoelastic substance seems appropriate.
Study was not ongoing after 1990
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