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Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?

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Abstract

Purpose

Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy.

Methods

In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP ≤ 12 mmHg, B: IOP ≤ 15 mmHg and C: IOP ≤ 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge!

Results

The mean age of patients was 46.32 ± 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of ≤ 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 ± 16.80% at last review and was 59.47 ± 16.07% in PACG, 62.40 ± 17.72% in POAG, 71.89 ± 8.50% in JOAG and 67.74 ± 18.10% in secondary glaucoma eyes. “Target” IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes.

Conclusion

Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.

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References

  1. Khaw PT, Chiang M, Shah P, Sii F, Lockwood A, Khalili A et al (2012) Enhanced trabeculectomy—the Moorfields safer surgery system. Dev Ophthalmol 50:1–28

    Article  PubMed  Google Scholar 

  2. Yu-Wai-Man C, Khaw PT et al (2015) Developing novel anti-fibrotic therapeutics to modulate post-surgical wound healing in glaucoma: big potential for small molecules. Expert Rev Ophthalmol. 10(1):65–76

    Article  CAS  PubMed  Google Scholar 

  3. Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA et al (2001) Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 108(11):1943–1953

    Article  CAS  PubMed  Google Scholar 

  4. Ederer F, Gaasterland DA, Dally LG, Kim J, VanVeldhuisen PC, Blackwell B et al (2004) The advanced glaucoma intervention study (AGIS). Comparison of treatment outcomes within race: 10-year results. Ophthalmology 111(4):651–664

    Article  PubMed  Google Scholar 

  5. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL et al (2012) Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 153(5):789–803

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bevin TH, Molteno AC, Herbison P et al (2008) Otago glaucoma surgery outcome study: long-term results of 841 trabeculectomies. Clin Exp Ophthalmol 36(8):731–737

    Article  PubMed  Google Scholar 

  7. Molteno ACB, Bosma NJ, Kittelson JM et al (1999) Long-term results of trabeculectomy—1976 to 1995. Ophthalmology 106:1742–1750

    Article  CAS  PubMed  Google Scholar 

  8. Landers J, Martin K, Sarkies N, Bourne R, Watson P et al (2012) A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology 119(4):694–702

    Article  PubMed  Google Scholar 

  9. Shaarawy TM, Sherwood MB, Grehn F (2009) WGA guidelines on design and reporting of glaucoma surgical trials, 93:17

  10. Hodapp E, Parrish RK II, Anderson DR (1993) Clinical decisions in glaucoma. C. V. Mosby, St. Louis, pp 52–61

    Google Scholar 

  11. Damji KF, Behki R, Wang L et al (2003) Canadian perspectives in glaucoma management: setting target intraocular pressure range. Can J Ophthalmol 38(3):189–197

    Article  PubMed  Google Scholar 

  12. Romero P, Hirunpatravong P, Alizadeh R, Kim E-A, Nouri-Mahdavi K, Morales E et al (2017) Trabeculectomy with mitomycin-C. J Glaucoma 27(2):1

    Google Scholar 

  13. Beckers HJM, Kinders KC, Webers CAB et al (2003) Five-year results of trabeculectomy with mitomycin C. Graefe’s Arch Clin Exp Ophthalmol 241(2):106–110

    Article  CAS  Google Scholar 

  14. Cillino S, Casuccio A, Di Pace F, Cagini C, Ferraro LL, Cillino G et al (2016) Biodegradable collagen matrix implant versus mitomycin-C in trabeculectomy: five-year follow-up. BMC Ophthalmol 16(4):24

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pathania D, Senthil S, Rao HL, Mandal AK, Garudadari CS et al (2014) Outcomes of trabeculectomy in juvenile open angle glaucoma. Indian J Ophthalmol 62(2):224–228

    Article  PubMed  PubMed Central  Google Scholar 

  16. Law SK, Modjtahedi SP, Mansury A, Caprioli J et al (2007) Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison. Eye 21(1):71–78

    Article  CAS  PubMed  Google Scholar 

  17. Tsai H-Y, Liu CJ, Cheng C-Y et al (2009) Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma. Br J Ophthalmol 93(7):943–948

    Article  PubMed  Google Scholar 

  18. Kirwan JF, Lockwood AJ, Shah P, Macleod A, Broadway DC, King AJ et al (2013) Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology 120(12):2532–2539

    Article  PubMed  Google Scholar 

  19. Gupta V, Ov M, Rao A, Sharma A, Sihota R et al (2012) Long-term structural and functional outcomes of therapy in juvenile-onset primary open-angle glaucoma: a five-year follow-up. Ophthalmologica 228(1):19–25

    Article  PubMed  Google Scholar 

  20. Tsai J-C, Chang H-W, Kao C-N, Lai I-C, Teng M-C et al (2003) Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma. Ophthalmologica 217(1):24–30

    Article  PubMed  Google Scholar 

  21. Jacobi PC, Dietlein TS, Krieglstein GK et al (1999) Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome. Ophthalmic Surg Lasers 30(8):637–646

    CAS  PubMed  Google Scholar 

  22. Chen CW, Huang HT, Bair JS, Lee CC et al (1990) Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol 6(3):175–182

    Article  PubMed  Google Scholar 

  23. Mermoud A, Salmon JF, Murray AD et al (1993) Trabeculectomy with mitomycin C for refractory glaucoma in blacks. Am J Ophthalmol 116(1):72–78

    Article  CAS  PubMed  Google Scholar 

  24. Kitazawa Y, Yamamoto T, Sawada A, Hagiwara Y et al (1996) Surgery for refractory glaucoma. Aust N Z J Ophthalmol 24(4):327–332

    Article  CAS  PubMed  Google Scholar 

  25. Sihota R, Angmo D, Ramaswamy D, Dada T et al (2018) Simplifying "target" intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian J Ophthalmol 66(2):495–505

    Article  PubMed  PubMed Central  Google Scholar 

  26. Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK, CIGTS Study Investigators (2009) Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors. Ophthalmology 116(2):200–207

    Article  PubMed  Google Scholar 

  27. Musch DC, Gillespie BW, Niziol LM, Lichter PR, Varma R, CIGTS Study Group for the CS (2011) Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 118(9):1766–1773

    Article  Google Scholar 

  28. Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE et al (2005) Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol 140(1):16–22

    Article  PubMed  Google Scholar 

  29. Olayanju JA, Hassan MB, Hodge DO, Khanna CL et al (2015) Trabeculectomy-related complications in Olmsted County, Minnesota, 1985 through 2010. JAMA Ophthalmol 133(5):574

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y et al (2016) Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol. 94(7):561–570

    Article  Google Scholar 

  31. AGIS (Advanced Glaucoma Intervention Study) Investigators (2001) The advanced glaucoma intervention study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol 119(12):1771–1779

    Article  Google Scholar 

  32. Sihota R, Angmo D, Sen S, Gupta V, Dada T, Pandey RM et al (2016) The long-term outcome of primary “bleb-sparing, epithelial exchange” in dysfunctional filtering blebs. J Glaucoma 25(7):571–578

    Article  PubMed  Google Scholar 

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Acknowledgements

I would like to thank all my patients for the participation.

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Authors and Affiliations

  1. Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India

    Ramanjit Sihota, Jyoti Shakrawal, Talvir Sidhu, Ajay K. Sharma & Tanuj Dada

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Veena Pandey

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  1. Ramanjit Sihota
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  2. Jyoti Shakrawal
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  3. Talvir Sidhu
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  4. Ajay K. Sharma
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Correspondence to Jyoti Shakrawal.

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Sihota, R., Shakrawal, J., Sidhu, T. et al. Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?. Int Ophthalmol 40, 1233–1243 (2020). https://doi.org/10.1007/s10792-020-01289-5

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  • DOI: https://doi.org/10.1007/s10792-020-01289-5

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