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R.G. Carassa, P. Bettin, M. Fiori, R. Brancato; Viscocanalostomy vs Trabeculectomy... Three Years After . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4296.
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Purpose: we previously reported the one-year outcome of a trial comparing the effectiveness and safety of viscocanalostomy and trabeculectomy in open-angle glaucoma. Objective of the present study was to present the 3-year results. Methods: fifty consecutive patients (50 eyes) with primary open-angle or pseudoexfoliative glaucoma scheduled for surgery were enrolled in a prospective study. Eyes were randomly assigned to either viscocanalostomy (Group 1) or trabeculectomy (Group 2) with no intraoperative antimetabolites. In Group 1 no further intervention was allowed, whereas trabeculectomy eyes could receive subconjunctival 5-fluorouracil injections or laser suture lysis postoperatively. Complete success "A" was defined as IOP between 6 and 21 mmHg (inclusive) on no medication. Complete success "B" was defined as IOP between 6 and 16 mmHg (inclusive) on no medication. Qualified success "A" and "B" were defined as above either with or without additional medication. Results: at the end of the 36-month follow-up complete success "A" was achieved in 52% in Group 1 and 67% in Group 2, while success "B" was obtained in 27% in Group 1 and 57% in Group 2. Qualified success "A" was achieved in 84% in Group 1 and 83% in Group 2, while qualified success "B" was obtained in 37% in Group 1 and 64% in Group 2 (Kaplan-Meier cumulative probability of success). Complications of trabeculectomy included 1 case of postoperative bleb bleeding with early transient IOP spike, 1 early hyphema, 5 cases of postoperative hypotony, 2 of them with a positive Seidel test from the conjunctival suture, 3 cases of transient choroidal detachment, 2 of them with shallow anterior chamber. No patient required reoperation. Two eyes required argon laser suture lysis, and 9 underwent one or more 5-FU injections, which caused punctate keratopathy in 3 eyes. One eye in Group 2 developed a late endophthalmitis with loss of light perception. During the follow-up, 24% and 44% of the eyes in Group 1 and 2 required phacoemulsification, respectively. Conclusions: these long-term data confirm that viscocanalostomy is an effective IOP-lowering procedure in adults affected by open-angle glaucoma. Trabeculectomy provides lower IOPs but greater complications.
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