Ahmad’s modified trabeculectomy technique

  • Syed Shoeb Ahmad Hospital Queen Elizabeth I
Keywords: endophthalmitis, filtering surgery, glaucoma, intraocular pressure, sclerostomy, trabeculectomy

Abstract

Aim or purpose: To present a modified technique of trabeculectomy.

Design: Ahmad’s modified trabeculectomy technique aims to utilize subtle modifications to the classical trabeculectomy technique in order to achieve a better filtering bleb leading to lesser complications.

Methods: Retrospective interventional case series.

Results: Thirty-four patients underwent this surgery. There was a significant difference in the preoperative and postoperative median intraocular pressure (IOP; z = 3.928; p < 0.001). The postoperative IOP (median = 12) was significantly lower than the preoperative IOP (median = 28; interquartile range = 9).

Conclusion: This modification can prove to be an effective method to reduce IOP with minimal complications.

References

Ahmad SS, Ghani SA, Rajagopal TH. Current concepts in the biochemical mechanisms of glaucomatous neurodegeneration. J Curr Glaucoma Pract. 2013;7:49-53.

Cankaya AB, Elgin U. Comparison of the outcome of repeat trabeculectomy with adjunctive Mitomycin C and initial trabeculectomy. Korean J Ophthalmol. 2011;25:401-408.

Kahook MY. Glaucoma surgery: how do we get from here to there? Middle East Afr J Ophthalmol. 2009;3:105-106.

Agarwal HC, Sharma TK, Sihota R, Gulati V. Cumulative effect of risk factors on short-term surgical success of Mitomycin augmented trabeculectomy. J Postgrad Med. 2002;48:92-96.

Zahid S, Musch DC, Niziol LM, Lichter PR. Collaborative Initial Glaucoma treatment Study Group. Risk of endophthalmitis and other long-term complications of trabeculectomy in the Collaborative Initial Glaucoma treatment Study (CIGTS). Am J Ophthalmol. 2013;155:674-680.

La Borwit SE, Quigley HA, Jampel HD. Bleb reduction and bleb repair after trabeculectomy. Ophthalmology. 2000;107:712-718.

Lee GA, Holcombe DJ. Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue. Eye. 2010;24:947-953.

Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC. Tube versus Trabeculectomy Study Group. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804-814.

Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III. Early and late complications. Eye. 2002;16:297-303.

Radhakrishnan S, Quigley HA, Jampel HD, et al. Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmology. 2009;116:1713-1718.

Stalmans I, Gillis A, Lafaut A-S, Zeyen T. Safe trabeculectomy technique: long term outcome. Br J Ophthalmol. 2006;90:44-47.

Coleman AL. Advances in glaucoma treatment and management: surgery. Invest Ophthalmol Vis Sci. 2012;53:2491-2494.

Vijaya L, Manish P, Ronnie G, Shantha B. Management of complications in glaucoma surgery. Indian J Ophthalmol. 2011;59(suppl 1):S131-S140.

Watson PG, Jakeman C, Ozturk M, Barnett MF, Barnett F, Khaw KT. The complications of trabeculectomy (a 20-year follow-up). Eye. 1990;4:425-438.

Casson R, Rahman R, Salmon JF. Long term results and complications of trabeculectomy augmented with low dose Mitomycin C in patients at risk for filtration failure. Br J Ophthalmol. 2001;85:686-688.

Papadopoulos M, Khaw PT. Improving glaucoma filtering surgery. Eye (Lond). 2001;15:131-132.

Gessesse GW, Damji KF. Advanced glaucoma: management pearls. Middle East Afr J Ophthalmol. 2013;20:131-141.

Furrer S, Menke MN, Funk J, Toteberg-Harms M. Evaluation of filtering blebs using the ‘Wuerzburg bleb classification score’ compared to clinical findings. BMC Ophthalmol. 2012;12:24.

Sharaawy T, Bhartiya S. Surgical management of glaucoma: evolving paradigms. Indian J Ophthalmol. 2011;59(suppl 1):S123-S130.

Ramakrishnan R, Khurana M. Surgical management of glaucoma: an Indian perspective. Indian J Ophthalmol. 2011;59(suppl):S118-S122.

Yamamoto T, Kuwayama Y. Interim clinical outcomes in the collaborative bleb related infection incidence and treatment study. Ophthalmology. 2011;118:453-458.

Page MA, Fraunfelder FW. Safety, efficacy, and patient acceptability of lidocaine hydrochloride ophthalmic gel as a topical ocular anesthetic for use in ophthalmic procedures. Clin Ophthalmol. 2009;3:601-609.

Carrillo MM, Buys YM, Faingold D, Trope GE. Prospective study comparing lidocaine 2% jelly versus sub-Tenon’s anaesthesia for trabeculectomy surgery. Br J Ophthalmol. 2004;88:1004-1007.

Guijjarro-Oria FJ, Gutierrez-Diaz E, Dorado-Lopez-Rosado AM, Montero-Rodriguez M, Lago-Llinas MD, Mencia-Gutierrez E. Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon’s anesthesia. Arch Soc Esp Oftalmol. 2013;88:102-107.

Lemon LC, Shin DH, Kim C, Bendel RE, Hughes BA, Juzych MS. Limbus-based vs fornix-based conjunctival flap in combined glaucoma and cataract surgery with adjunctive mitomycin C. Am J Ophthalmol. 1998;125:340-345.

Alwitry A, Patel V, King AW. Fornix vs limbus based trabeculectomy with mitomycin C. Eye (Lond). 2005;19:631-636.

Wells AP, Cordiero MF, Bunce F, Khaw PT. Cystic bleb formation and related complications in limbus-versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with Mitomycin C. Ophthalmology. 2003;110:2192-2197.

Kuroda U, Inoue T, Awai-Kasaoka N, Shobayashi K, Kojima S, Tanihara H. Fornix-based versus limbal-based conjunctival flaps in trabeculectomy with Mitomycin C in high-risk patients. Clin Ophthalmol. 2014;15(8):949-954.

Gedde SJ. Results from the tube versus trabeculectomy study. Middle East Afr J Ophthalmol. 2009;16:107-111.

Filippopoulos T, Hanna E. Correlation of filtration bleb morphology with histology. Int Ophthalmol Clin. 2009;49:71-82.

Anand N, Arora S, Clowes M. Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing and leaks. Br J Ophthalmol. 2006;92:175-180.

Published
2019-11-23
How to Cite
Ahmad, S. (2019). Ahmad’s modified trabeculectomy technique. Asian Journal of Ophthalmology, 16(4), 231-240. https://doi.org/10.35119/asjoo.v16i4.391

Most read articles by the same author(s)