Publications (3)6.54 Total impact
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ABSTRACT: To examine the rates of intermediate-term intraocular pressure (IOP) control after trabeculectomy with adjunctive mitomycin C (MMC) and assess for associated complications. Medical records of patients undergoing primary trabeculectomy with MMC at Concord Repatriation Hospital, Sydney between January 1997 and December 2005 were reviewed. All eyes with a minimum of 2-year follow up were included. Follow-up data were collected in a standardized form on postoperative IOP, bleb-related and other complications. Success was measured as IOP ≤ 18 mmHg and ≥ 6 mmHg (criteria 1) with (qualified success) or without (absolute success) the use of glaucoma medications. A secondary outcome measure was an IOP reduction of greater than 20% from baseline (criteria 2). Eyes with preoperative IOP of 18 mmHg or less were included, but also analysed separately to those eyes with preoperative IOP above 18 mmHg. Sixty eyes from 42 patients were included in the study, with 3-year follow up on 48 eyes. Mean preoperative IOP was 25.3 mmHg (range 8-45) and mean postoperative IOP was 14.0 mmHg at 1- and 2-year follow up, and 14.7 mmHg at 3 years (ranges: 3-31, 4-30 and 8-45 mmHg respectively). Cumulative success for criteria 1 was 85.0% at 2 years and 83.3% at 3 years, and for criteria 2 it was 80.0% and 79.2%, respectively. The number of eyes on glaucoma medications was reduced from 51 preoperatively to 30 at 3 years. Complications were infrequent. There was one eye with a shallow anterior chamber beyond the immediate postoperative period. One eye required cataract surgery at 1-year follow up. Subgroup analysis was performed using the first operated eye only, and results did not differ significantly from overall results. MMC-augmented trabeculectomy can significantly reduce IOP in the short and intermediate term, with a favourable safety profile.
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ABSTRACT: To evaluate our surgical technique of bleb revision using scleral patch graft and conjunctival advancement, the long-term outcome and the ability to maintain adequate intraocular pressure (IOP) control. Retrospective review. Eighteen patients were identified. The mean age was 72.1+/-4.3 years (95% confidence limits). In 12 of the 18 cases, the posterior edge of scleral patch graft was secured with fixed sutures, in another 3 with releasable sutures and in the remaining 3 with adjustable sutures. The mean follow-up period was 23.7+/-5.4 months (95% confidence limits). The mean preoperative IOP was 7.6+/-3.0 mm Hg (95% confidence limits), increased to 13.1+/-1.6 mm Hg (P=0.02) postoperatively. Twelve of the 18 patients had a minimum of 2-year follow-up. At this time point, 7 out of 12 (58%) patients had IOP <21 mm Hg without any medication, 9 out of 12 (75%) patients had IOP <21 mm Hg with medication, 7 out of 12 (58%) patients had IOP <16 mm Hg without medication, and 9 out of 12 (75%) had IOP <16 mm Hg with medication. The mean number of 5-fluorouracil injections with or without needling was significantly higher in the success group than in the failure group (P=0.035). This series illustrates a useful technique using a scleral patch graft in cases of full-thickness scleral defect encountered during bleb revisions. The success rates achieved are comparable to those in the published literature, and furthermore our successful cases achieved lower IOPs appropriate for patients with advanced glaucoma.