Surgical Outcomes of Combined Trabeculectomy-Cyclodialysis for Glaucoma

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Abstract

Purpose:

To determine the performance of combined trabeculectomy-cyclodialysis surgery over a 25-year period.

Methods:

A retrospective cohort study of 55 eyes (39 patients) treated between 1987 and 2012 was performed.

Methods:

The following data were collected: age, sex, glaucoma etiology, preoperative and postoperative number of topical medications, preoperative and postoperative laser trabeculoplasty, intraoperative and postoperative 5-fluorouracil application, lens status at the time of surgery, postoperative cataract surgery, duration of follow-up, and complications. Best-corrected LogMAR visual acuity was assessed preoperatively, at 1 year, and then at 2-yearly intervals for the duration of follow-up. Intraocular pressure (IOP) was assessed preoperatively and then at 1 week, 4 weeks, 1 year, and then at 2-yearly intervals for the duration of follow-up. Visual field indices were collected at baseline and at the completion of follow-up.

Methods:

Failure was defined as reoperation for glaucoma, progression to legal blindness, IOP≤5 mm Hg, >21 mm Hg, or <20% reduction below baseline. All others were a “complete success” if no additional topical medication was required and a “qualified success” if medication was required. Analyses using 18 and 15 mm Hg as upper limits for success were also performed.

Results:

Mean IOP fell from 25.2 to 11.9 mm Hg over a mean 11.2 years. At completion of follow-up 32 eyes (58.2%) achieved an unqualified success, 18 (32.7%) a qualified success, and 5 (9.1%) a failure. No patient progressed to legal blindness. Cases with greater preoperative IOP had a greater reduction in IOP (P<0.0001). On univariate analysis no intraoperative application of antimetabolite (OR, 0.74; 95% CI, 0.49-0.94; P=0.022) and a longer follow-up (OR, 1.16; 95% CI, 1.02-1.33; P=0.025) predicted a higher final IOP; these were not significant on multivariate analysis. Thirty-six of 47 phakic eyes developed cataract; the majority occurred in the first 4 years.

Conclusion:

Combined trabeculectomy-cyclodialysis produces sustained lowering of IOP for long periods of time, despite a cataractogenic effect.

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