Augmentation of Filtering Blebs with Viscoelastics in Trabeculectomy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy(VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. Methods: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site atthe end of CT and a balanced salt solution was injected into the anterior chamber. This procedure inducedmigration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment ofan intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of successwithout antiglaucoma medication, it was regarded as a complete success. Results: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week,and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group(75%), though the qualified success rate was not different between the two groups. The number of IOP-loweringmedications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p= 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p< 0.001). Conclusions: Placing VE within the bleb at the end of surgery may result in better IOP control and less need forIOP-lowering medication without any additional materials, cost, or time.
Abstract
Purpose: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy(VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. Methods: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site atthe end of CT and a balanced salt solution was injected into the anterior chamber. This procedure inducedmigration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment ofan intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of successwithout antiglaucoma medication, it was regarded as a complete success. Results: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week,and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group(75%), though the qualified success rate was not different between the two groups. The number of IOP-loweringmedications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p= 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p< 0.001). Conclusions: Placing VE within the bleb at the end of surgery may result in better IOP control and less need forIOP-lowering medication without any additional materials, cost, or time.
참고문헌 (18)
- Azuara-Blanco A, "Dysfunctional filtering blebs", Surv Ophthalmol, 43, pp.93~126 (1998)
- Stewart WC, "Early postoperative prognostic indicators following trabeculectomy", Ophthalmic Surg, 22, pp.23~26 (1991)
- Allingham RR, "Shields’ textbook of glaucoma", pp.565~595 (2005), Lippincott Williams & Wilkins
- Haynes WL, "Control of intraocular pressure after trabeculectomy", Surv Ophthalmol, 43, pp.345~355 (1999)
- Vijaya L, "Management of complications in glaucoma surgery", Indian J Ophthalmol, 59(Suppl), pp.S131~S140 (2011)
- Hau S, "Corneal complications of glaucoma surgery", Curr Opin Ophthalmol, 20, pp.131~136 (2009)
- Fourman S, "Management of cornea-lens touch after filtering surgery for glaucoma", Ophthalmology, 97, pp.424~428 (1990)
- Shin DH, "Management of flat anterior chamber with hypotonia after glaucoma surgery", Glaucoma, 4, pp.193~197 (1982)
- Stewart RH, "A method of managing flat anterior chamber following trabeculectomy", Ophthalmic Surg, 11, pp.382~383 (1980)
- Kurtz S, "Combined perfluoropropane gas and viscoelastic material injection for anterior chamber reformation following trabeculectomy", Br J Ophthalmol, 86, pp.1225~1227 (2002)
- Geyer O, "Stabilization of post-trabeculectomy flat anterior chamber with Healon and sulfur hexafluoride", J Cataract Refract Surg, 29, pp.2026~2028 (2003)
- Higashide T, "Use of viscoelastic substance in ophthalmic surgery: focus on sodium hyaluronate", Clin Ophthalmol, 2, pp.21~30 (2008)
- Bowers D, "Hyaluronic acid-carboxymethylcellulose film and perianastomotic adhesions in previously irradiated rats", Am J Obstet Gynecol, 181, pp.1335~1337 (1999)
- Osada H, "The effect of hyaluronic acid-carboxymethylcellulose in reducing adhesion reformation in rabbits", J Int Med Res, 27, pp.292~296 (1999)
- Burns JW, "Preclinical evaluation of Seprafilm bioresorbable membrane", Eur J Surg Suppl, (577), pp.40~48 (1997)
- Ouaissi M, "Post-operative adhesions after digestive surgery: their incidence and prevention:review of the literature", J Visc Surg, 149, pp.e104~e114 (2012)
- Takeuchi K, "Solid hyaluronic acid film and the prevention of postoperative fibrous scar formation in experimental animal eyes", Arch Ophthalmol, 127, pp.460~464 (2009)
- Tsurumaru N, "Seprafilm as a new antifibrotic agent following trabeculectomy in rabbit eyes", Jpn J Ophthalmol, 53, pp.164~170 (2009)