ABSTRACT
<p><b>Background</b>Trabeculectomy is the most efficient surgical treatment. Prevention failure of bleb cicatrix would lead to unsatisfactory postoperative intraocular pressure (IOP) controlling and unsatisfactory success rate. The aim of this study was to evaluate the 5-year outcomes of trabeculectomy with a cross-linked sodium hyaluronate gel implantation for Chinese glaucoma patients.</p><p><b>Methods</b>This is a prospective, case-controlled study. Patients who were to be applied first-time trabeculectomy in the Department of Ophthalmology of Peking University Third Hospital between 2010 and 2012 were included in the study. Totally, 60 eyes were randomly assigned to the trabeculectomy group (TA group) or the trabeculectomy with cross-linked sodium hyaluronate gel implantation group (TH group). Follow-up was finished at 1 week, 1 month, 3 months, 1 year, 3 years, and 5 years after the operation. The statistical index of demographic data, IOP, bleb shape, and any complications or medications or surgical procedures were recorded and assessed by SPSS 19.0 software through independent t-test, one-way analysis of variance (ANOVA) and Pearson's Chi-square test, respectively.</p><p><b>Results</b>The baseline IOP was comparable between the two groups (t= -1.00, P= 0.32) while the postoperative IOP was significantly lower in the TH group at 1, 3 and 5 years' time points (P = 0.00, P= 0.01 and P = 0.01, respectively). According to the Indiana Bleb Appearance Grading Scale, the height and extent of bleb were better in the TH group at all follow-up time points (P < 0.05), however, the comparison of bleb vascularity showed no statistical difference (P > 0.05). TA group had a higher percentage of complications (13% vs. 3%) compared to TH group; however, there was no statistical difference in the comparison of each statistical item (P > 0.05, respectively). The complete success at 5 years was higher in the TH group than that in the TA group (78% vs. 54%, P = 0.03).</p><p><b>Conclusion</b>Our results suggested that implantation of cross-linked sodium hyaluronate gel with trabeculectomy was more efficient and would improve the prognosis of glaucoma patients.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Follow-Up Studies , Glaucoma , Therapeutics , Hyaluronic Acid , Therapeutic Uses , Intraocular Pressure , Prospective Studies , Trabeculectomy , Treatment OutcomeABSTRACT
<p><b>Background</b>The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients.</p><p><b>Methods</b>This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percentages, and complications. Success was defined as an IOP <21 mmHg and at least a 20% IOP reduction from baseline after 3 months for any two consecutive visits, without additional glaucoma surgery. The data were processed using the R Stats Package version 3.0.0. The Wilcoxon test was used to compare the postoperative IOP and the number of glaucoma medications with baselines. The Kaplan-Meier test was used to calculate the 2-year success percentage. The risk factors related to Trabectome failure were determined by logistic regression.</p><p><b>Results</b>A total of 120 glaucoma patients were enrolled. The Trabectome efficiently reduced the IOP from a baseline of 22.8 ± 1.34 mmHg to 17.6 ± 0.96 mmHg, and the use of glaucoma medications from 2.2 ± 0.17 mmHg to 1.4 ± 0.21 in a 2-year follow-up (both, P < 0.01). The overall success percentage was 80%. No risk factor related to Trabectome failure was identified. No vision-threatening complication was observed. Ten patients, who required secondary glaucoma surgery, all reached the target IOP.</p><p><b>Conclusions</b>In a 2-year follow-up, Trabectome was an efficient and safe procedure for Chinese glaucoma patients.</p>