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M.M. Shiew, D.P. O'Brart; Comparison of Trabeculectomy with Viscocanulostomy with Adjunctive Anti-metabolite Usage: A Randomised, Prospective Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1213.
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Purpose: To compare trabeculectomy with viscocanulostomy for the control of intraocular pressure (IOP) in open angle glaucoma (OAG) uncontrolled by medical therapy. Methods: 45 patients (50 eyes) were randomised to trabeculectomy (25 eyes) or viscocanulostomy (25 eyes). Eyes in both groups were graded on the basis of risk factors for drainage failure and given intraoperative antimetabolites (5-Fluoruracil 25mg/ml (5-FU), Mitomycin-C (MMC) 0.2mg/ml & 0.4 mg/ml) according to a protocol. Results: There were no differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure and preoperative IOP. Mean follow-up was 16 months (range 3-24 months). At the last follow-up visit, complete success (IOP <21 mmHg without anti-glaucoma medications) was seen in 19 eyes (76%) undergoing trabeculectomy, but in only 43% of eyes undergoing viscocanulostomy (p<0.05). At the last follow-up visit, the average number of anti-glaucoma medications was 0.32 in the trabeculectomy group compared to 1.1 for viscocanulostomy (p<0.05). Early bleb leaks, hyphaema and transient shallowing of the anterior chamber were more common after trabeculectomy (p<0.05). Conclusions: Previous studies suggest trabeculectomy achieves better IOP control than stand-alone viscocanulostomy. This study supports these findings in the setting of viscocanulostomy augmented with anti-metabolites. Viscocanulostomy is associated with fewer early post-operative complications, although significant complications permanently impairing vision did not occur with either technique.
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