Simplified Trabeculectomy Shows Fewer Complications

■ Researchers at the University of Texas Medical Branch, led by Bennett Y. Hong, MD, conducted a retrospective 5-year consecutive case series from a single surgeon to evaluate outcomes and safety of a modified, fornix-based trabeculectomy procedure with adjunct mitomycin C aimed at minimizing postoperative issues. Elements of the procedure include a 3-mm peritomy, no peripheral iridectomy, and an overlying triangular scleral flap secured by a single interrupted nylon suture.

A total of 459 cases met these criteria, of which 69 were randomly selected for preliminary analysis. There were 56 trabeculecomies (81.2%) and 13 phacotrabeculecomies (18.8%).

Mean baseline IOP was 25.04 mmHg, including 30 (43.5%) with IOP ≤21 mmHg, which improved at postoperative year (POY) 1 to a mean of 13.78 mmHg and POY2 to a mean of 14.93 mmHg. The average number of preoperative IOP-lowering medications was 2.72 compared to 1.01 at final visit. Snellen visual acuity loss of >2 lines occurred in 15.9% (POY1) and 17.1% (POY2), but the average visual acuity remained unchanged from baseline.

The researchers, who presented their study at the recent ARVO meeting, concluded that this technique showed a high success rate similar to other published success rates for trabeculectomy. In addition, there was a low incidence of complications, including no instances of hyphema, shallow anterior chamber, or hypotony maculopathy. The postoperative course was more predictable and in particular, there was a low rate of suture lysis. Finally, the study comprised a heterogeneous patient mix with a larger patient cohort than most trabeculectomy-only studies. The researchers noted that additional analysis is warranted to validate the technique.