Effects of Management on High Intraocular Pressure after Trabeculectomy

ABSTRACT

PURPOSE: To investigate the effect of stepwise procedures on high intraocular pressure (IOP) after trabeculectomy. METHODS: A retrospective review was coducted on the medical records of patients who underwent trabeculectomy between January 1997 and December 2002. at the Chungbuk National University Hospital. Analysis included 136 eyes from 118 patients who received at least 6 months of follow-up care (mean 22.4+/-18.1 months). High IOP during the early postoperative period was identified in 104 of the 136 eyes, and these were treated by the following methods in a stepwise manner (1) cotton-tip application (a slow, steady eyeball pressure with a sterile cotton tip was favored), (2) scleral flap suture cutting (26-gauge needle), (3) needling of the bleb (without antimetabolites), (4) additional antiglaucoma medication. If none of the above management techniques was successful, the surgery was repeated. After cotton tip application or scleral flap suture cutting, patients were divided into the recovery group (IOP was reduced) and the non-recovery group. RESULTS: Success rates were 11.8% for cotton-tip application, 15.4% for scleral flap suture cutting, 0.7% for needling without antimetabolites, and 28.7% for additional antiglaucoma medication. The overall success rate was 80.1%. Pre-interventional factors associated with the non-recovery group were higher preoperative IOP (p=0.003) and diabetes (p=0.017). CONCLUSIONS: Four procedures were used, in a stepwise manner, to reduce IOP following trabeculectomy. IOP was found to decrease to desirable levels without the use of antiglaucoma medication in 27.9% of all subjects.