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D.E. Grigera, E. Morales, S. García–Girado, H.J. Fontana, G.D. Volpe; New Approach to Limbus–Based Trabeculectomy With Adjunctive 5–FU: Obtaining Short Linear Conjunctival Incisions Separated From the Trabeculectomy Site. A Retrospective Study . Invest. Ophthalmol. Vis. Sci. 2005;46(13):91.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the results of a modified limbus–based trabeculectomy technique designed to enhance aqueous filtration. Methods: Retrospective, non–comparative interventional case series. A small–length, 6mm conjunctival incision at 10–12mm from the trabeculectomy area is performed, thus minimizing the interaction between the two healing processes. A specially designed conjunctival microretractor is used to facilitate access to the limbus through such an incision. Intraoperative 5–FU (50 mg/ml for five minutes) is applied. Population: 65 eyes of 52 patients with uncontrolled glaucoma and submitted to trabeculectomy between 1999 and 2004. Results: Median patient age was 64 years (percentil 25=53; percentil 75=69). Diagnosis: 43.07% of the eyes had Primary Open Angle Glaucoma, 24.6% Primary Closed Angle Glaucoma, 12.3% Pseudoexfoliation Glaucoma, 10.7% Juvenile Glaucoma, and Pigmentary , Traumatic and Congenital Glaucomas, 3% each. Median follow–up was 14 months (percentil 25=10; percentil 75=24), range 6 to 70 months. Sixty six percent of the eyes were under two–drug hypotensive treatment, 24% used four drugs, 6.15% 2 drugs and 3.08% 1 drug. Cup/disc ratio was <0.5 in 10.8% of the eyes, > 0.5 < 0.8 in 35.4% and > 0.8 in 58.5%. According to Brusini's Glaucoma Staging System for Standard Automated Perimetry, 15.4% of the eyes were stage 0 to 1, 43.6% were stage 2 to 3, and 41.02% were stage 4 to 5. The median of preoperative IOP values under treatment was 24mmHg (percentil 25=20; percentil 75=28) and the median of postoperative IOP values was 12mmHg (percentil 25=10; percentil 75=15). The comparison of these values by Wilcoxon signed–rank test was z = 7.002; p< 0.00001. With surgery alone an IOP under 21 mmHg could be obtained in 83.07% (54) of the eyes, under 15 mmHg in 67.7% (44) and under 12mmHg in 40% (26). Including topical medication, 95.38% (62) ended under 21mmHg, 76.92% (50) under 15mmHg and 41.53% (27) under 12mmHg. Twelve eyes received postoperative 5–FU injections and 4, a bleb needling procedure. Complications: 2 eyes of the same patient had ciliary block glaucoma which was resolved, 2 eyes developed clinically detectable choroidal detachments, 2 developed cataracts, 3 had transient anterior chamber reduction, and 1 had hyphema. Conclusions: Hypotensive effect was considered adequate for this group of patients. The procedure had few complications. Prospective, comparative randomized trials are needed.
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