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Trabeculectomy Essay

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Is axial length a risk factor for trabeculectomy failure?
Introduction:

Glaucoma has been recorded as a major cause of preventable blindness and myopia and high myopia (AL of ≥26.0 mm) has been recognised as a major risk factor for the development of glaucoma. Worldwide, the prevalence of myopia has been increasing; hence, the prevalence of glaucoma associated with high myopia has also been increasing. IOP-reducing treatments are the best evidence-based therapy for glaucoma as high intraocular pressure (IOP) was the most important factor associated with the development of glaucomatous damage. Trabeculectomy with use of antimetabolites has increased the success rate in such cases. However,many risk factors for trabeculectomy failure have been
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All patients received topical antibiotics and topical steroids for 1–3 months after the surgery. Sutures anchoring the conjunctiva and Tenon capsule to the limbus were removed after 1 month of the surgery. Postoperative interventions like digital ocular massage, laser suture lysis and anterior chamber reformation were recommended based on the IOP, conjunctival bleb shape, anterior chamber depth and presence/absence of complications. If a postoperative IOP elevation was due to insufficient filtration, laser suture lysis was recommended and if the IOP still remains high bleb revision surgery was performed. Surgical success was defined as an high intraocular pressure (IOP) of ≤21 mmHg (criterion A), ≤18 mmHg (criterion B), or ≤15 mmHg (criterion C), with a lower IOP cut-off of 6 mmHg and a [20 % reduction regardless of the use of antiglaucoma medication. Statistical tests were performed where P…show more content…
11.5 ± 11.7, P = 0.75) after the surgery.
• The 3-year success rates regardless of antiglaucoma medication use of the high myopia group and the non-high myopia group were 62.3 and 56.9 % based on criterion A (P = 0.78),
• 57.0 and 54.3% based on criterion B (P = 0.94) and 51.7 and 39.0 % based on criterion C (P = 0.55), respectively. Figure 1a-c

Figure 1: Survival analysis curve for the success of trabeculectomy in the high myopia group (19 eyes) and non-high myopia group (54 eyes). a- Survival analysis curve based on criterion A; b- Survival analysis curve based on criterion B; c- Survival analysis curve based on criterion C
Adapted from: Tanaka D et al.

• Younger age, preoperative and pseudophakia shorter AL was found to be significant risk factors for trabeculectomy failure based on an IOP of ≥15 mmHg (criterion C).
• Age and pseudophakia also had significant effects on trabeculectomy failure based on criteria A and B and the AL had a significant influence based on criterion A.
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