Trabeculectomy for Medically Uncontrolled Acute Primary Angle-Closure Glaucoma

Hee Chang Mun; Kwon Yoo Chung; Yeon Kim Yong

doi:10.3341/jkos.2009.50.8.1242

Journal List > J Korean Ophthalmol Soc > v.50(8) > 1008342

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Mun, Chung, and Yong: Trabeculectomy for Medically Uncontrolled Acute Primary Angle-Closure Glaucoma

Original Article

J Korean Ophthalmol Soc 2009;50(8):1242-1246.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.8.1242

Trabeculectomy for Medically Uncontrolled Acute Primary Angle-Closure Glaucoma

Hee Chang Mun, MD, Kwon Yoo Chung, MD, PhD, Yeon Kim Yong, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Yong Yeon Kim, MD, PhD Department of Ophthalmology, Guro Hospital, Korea University College of Medicine #97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: yongykim@mail.korea.ac.kr

Received 6 January 200928 April 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To evaluate the outcomes of trabeculectomy performed on eyes with medically uncontrolled acute angle closure glaucoma (AACG).

Methods:

The authors reviewed 31 eyes of 30 acute primary angle-closure glaucoma patients who had undergone trabeculec-tomy. The eyes were divided into two groups: eyes which did not respond to medical and/or laser treatment (Group A, 16 eyes) and those which initially responded to medical and/or laser treatment and later had an intraocular pressure (IOP) increase (Group B, 15 eyes). Complete success was defined as a final IOP below 21 mmHg without medication, and qualified success was defined as a final IOP below 21 mmHg with medication. Patients whose postoperative IOP was 22 mmHg or greater on at least two serial measurements or who required additional glaucoma surgery were classified as failures.

Results:

The mean follow-up was 43.1±32.3 months. The five-year qualified success rate was 56.3% in Group A and 100% in Group B (log-rank test, p=0.02). The preoperative IOP was significantly higher in Group A (38.0±11.5 mmHg) than in Group B (21.8±12.2 mmHg) (p <0.01). Factors found not to be significant included age, gender, peripheral anterior synechiae, a glauco-matous optic disc, and visual field damage. The postoperative complications were similar between the two groups (p >0.05).

Conclusions:

The medically uncontrolled AACG appears to have an adverse effect on the outcome of trabeculectomy. Success of trabeculectomy in AACG seems to be inversely related with elevated preoperative intraocular pressure.

Keywords: Acute angle closure glaucoma, Medically uncontrolled, Trabeculectomy

References

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Figure 1.

Kaplan-Meier survival curve for patients undergoing trabeculectomy for medically uncontrolled acute angle-closure glaucoma. The qualified success rate was 78.8% at 1 year and 56.3% at 5 years for Group A; 100% both at 1 year and at 5 years for Group B (log− rank test, p=0.02).

Figure 2.

Kaplan-Meier survival curve for patients undergoing trabeculectomy for medically uncontrolled acute angle-closure glaucoma. The complete success rate was 62.5% at 1 year and 41.7% at 5 years for Group A; 65.5% at 1 year and 43.6% at 5 years for Group B (log-rank test, p=0.46).

Table 1.

Baseline preoperative characteristics of two groups

	Group A (n=16)	Group B (n=15)	p-value
Age (years)	68.5±6.8	69.5±10.0	0.74^†
Sex (male:female)	1:15	3:12	0.33^‡
Eyes (right:left)	7:9	7:8	0.86^‡
DM	4	2	0.39^‡
HTN	7	6	1.00^‡
IOP at first visit	56.4±11.5	51.1±12.7	0.23^†
Preoperative IOP (mmHg)	38.0±11.5	21.8±12.2	<0.01^†
Interval of last attack to surgery	16.2±13.6	10.3±2.6	0.06^†
Cup to disc ratio	0.7±0.3	0.7±0.2	0.16^†
Gonioscopic finding (PAS>180°)	11 / 12	8 / 11	0.30^∗
Laser iridotomy	4 / 16	10 / 15	0.14^∗
Intraoperative use of MMC	3 / 16	1 / 15	0.60^∗
Number of preoperative medications	3.6±1.3	3.5±1.0	0.44^†
Number of eye drops at last visit	0.5±0.6	0.8±1.0	0.33^†
Preoperative VA (log MAR)	1.1±0.7	0.6±0.6	0.06^†
Postoperative VA (log MAR)	1.1±0.7	0.6±0.6	0.05^†

^∗ Fisher's exact test

^† Independent T-test

^‡ Pearson chi-square test; DM=diabetes mellitus; HTN=hypertension; IOP=intraocular pressure; VA=visual acuity; PAS=peripheral anterior synechiae; MMC=0.02% mitomycin C.

Table 2.

Postoperative complications

Complications	Group A (n=16)	Group B (n=15)
Shallow anterior chamber	2	0
Transient hypotony	4	4
Hyphema	0	0
Cataract	6	7
Endophthalmitis	0	0
		p=0.72^∗

^∗ Chi-square test.

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