Modern trabeculectomy outcomes
Reviewed by Brian Ang

This audit was conducted by the Trabeculectomy Outcomes Group Audit Study Group to report on the efficacy and safety of current trabeculectomy surgery in the UK. This is relevant in light of the fact that the trabeculectomy outcomes presented by the UK National Trabeculectomy Survey were based on data collected 15 years ago, and thus in need of being updated. The evolution of glaucoma surgery over the past two decades has been immense, and includes the increasing use of intraoperative mitomycin C, releasable and adjustable sutures and postoperative 5-fluorouracil (5-FU) injections, which have all purportedly contributed to safer surgery with less postoperative complications. The audit looked at trabeculectomy outcomes of 428 eyes of 395 patients with primary open angle or pseudoexfoliation glaucoma. At the end of two years, the mean intraocular pressure (IOP) had reduced from 23mmHg preoperatively to 12.4mmHg. IOP of 18mmHg or less and 20% reduction of preoperative IOP was achieved without any IOP-lowering medications in 78% and with medications in 86%. Many eyes required post-trabeculectomy interventions, such as suture manipulation (43%), postoperative 5-FU injections (28%) and bleb needling (17%). The commonest postoperative complication was bleb leak (14%) followed by bleb encystment (7.7%). Hypotony (3%) was relatively uncommon, as was bleb-related infection (1%). The results of this survey confirm that with the current modern surgical techniques, trabeculectomy outcomes have improved, with better IOP control and lower rates of serious complications, although this was associated with the need for intensive proactive postoperative care. 

Trabeculectomy in the 21st century – a multicenter analysis.
Kirwan JF, Lockwood AJ, Shah P, et al.
OPHTHALMOLOGY
2013;120:2532-9.