Resultados de una técnica quirúrgica de trabeculectomía ab-externo modificada en pacientes con glaucoma de ángulo abierto / Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma

Objetivo Evaluar la seguridad y la eficacia de una técnica quirúrgica de trabeculectomía ab-externo modificada en el control de la presión intraocular (PIO) en los pacientes con glaucoma de ángulo abierto. Método y análisis Estudio retrospectivo de corte transversal en el que se incluyeron pacientes con glaucoma de ángulo abierto sometidos a trabeculectomía ab-externo modificada como primer tratamiento quirúrgico filtrante entre enero de 2008 a marzo de 2015. En el postoperatorio se evaluó la PIO, los medicamentos hipotensores, los tratamientos adicionales y las complicaciones tempranas y tardías. Resultados Se analizaron datos de 48 ojos de 38 pacientes. La media de edad fue de 63,1 años (25 a 85 años) y el tiempo medio de seguimiento fue de 35,3 meses (rango: 1-147 meses). La PIO preoperatoria media fue de 25,21±3,48mmHg y de 15,83±4,4mmHg al final del seguimiento. Catorce ojos (29%) requirieron goniopunción con láser y 4 ojos needling (8,4%). El análisis de supervivencia de Kaplan-Meier mostró una tasa de éxito del 81,7% a los 2 años y del 54,9% del año 4 al año 12. Dos ojos presentaron desprendimiento coroideo, 3 ojos cataratas que requirieron cirugía y 5 ojos tuvieron fugas tempranas de la ampolla. Conclusiones La trabeculectomía ab-externo modificada es eficaz para el tratamiento del glaucoma de ángulo abierto con un buen control de la PIO a largo plazo y una baja incidencia de complicaciones quirúrgicas, y podría utilizarse en casos complejos seleccionados de acuerdo con los resultados obtenidos (AU)

Objective Assess the safety and efficacy of a modified ab-external trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysis Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. Results Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the follow-up time was 35.3 months (range of 1-147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. Conclusions This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results (AU)

Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma.

OBJECTIVE: Assess the safety and efficacy of a Modified Ab-externo Trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. METHODS AND ANALYSIS: Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. RESULTS: Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the mean follow-up time was 35.3 months (range of 1147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. CONCLUSIONS: This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.