Korean J Ophthalmol.  2014 Oct;28(5):393-398. 10.3341/kjo.2014.28.5.393.

Augmentation of Filtering Blebs with Viscoelastics in Trabeculectomy

• Jeong H
• Sung KR

• KMID: 2344263
• DOI: http://doi.org/10.3341/kjo.2014.28.5.393

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 at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration 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 of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without 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-lowering medications 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 for IOP-lowering medication without any additional materials, cost, or time.

Keyword

Anti-fibrotic agent; Glaucoma; Hyaluronic acid; Trabeculectomy; Viscoelastics

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Combined Modality Therapy
Female
Follow-Up Studies
Glaucoma/*surgery
Humans
Hyaluronic Acid/*therapeutic use
Intraocular Pressure/physiology
Male
Middle Aged
Tonometry, Ocular
Trabeculectomy/*methods
Viscosupplements/*therapeutic use
Hyaluronic Acid
Viscosupplements

Figure

• 

  Fig. 1 At the end of conventional trabeculectomy approximately half of the anterior chamber space was filled with viscoelastics (Healon) via the paracentesis site.

• 

  Fig. 2 A small amount of balanced salt solution (BSS) was injected into the anterior chamber via the same paracentesis site. This procedure induced migration of viscoelastics from the anterior chamber into the bleb space. Thus, the bleb was elevated by the underlying viscoelastics.

• 

  Fig. 3 Half of the anterior chamber space was again filled with viscoelastics.

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  Fig. 4 The cumulative success rate of the viscoelastics-augmented trabeculectomy (VAT) and conventional trabeculectomy (CT) groups determined by Kaplan Meier Analysis.

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