“CLINICAL OUTCOMES OF VARIOUS SURGICAL MODALITIES IN CASES OF REFRACTORY GLAUCOMA”

Abstract

The study was conducted to evaluate the clinical outcomes of various glaucoma surgeries (trabeculectomy, trabeculectomy with mitomycin-C and glaucoma valve implantation) in cases of refractory glaucoma. When it becomes obvious that medication will not help then alternatives should be tried.These alternatives can be in form of :- Filtration Surgery Termed as trabeculectomy allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed. Trabeculectomy with mitomycin C-The use of antifibrotic agents such as mitomycin-C and 5-fluorouracil, along with releasable sutures or laser suture lysis, enhances the longevity of guarded procedures, Drainage Implants Glaucoma drainage devices are designed to divert aqueous humor from the anterior chamber to an external reservoir, where a fibrous capsule forms about 4-6 weeks after surgery and regulates flow. Aims of Study 1. Study the clinical outcomes of trabeculectomy,trabeculetomy with mitomycin-C and glaucoma valve implantation in management of refractory glaucoma patients. 2.Evaluate the complications of glaucoma valve surgery. 3.Study the complications of trabeculectomy,trabeculectomy with mitomycin-C. The proposed study was conducted in upgraded department of ophthalmology,LLRM Medical College,Meerut. Population characteristics were number of eyes treated,diagnosed and follow up.The study was a prospective study with random selection of patients done from the OPD.The randomly selected patients were then divided into three groups, one group was subjected to trabeculectomy, second with trabeculectomy with mitomycin-C and the other group was subjected to glaucoma valve implantation. CRITERIA FOR FAILURE OF SURGERY: Ÿ IOP > 21 mm hg at end of 1 year or Ÿ IOP not reduced by 20% from baseline at end of 1 year or Ÿ IOP <=5 mm hg at end of 1 year At 1 year postoperatively mean IOP for trabeculectomy, trabeculectomy with mitomycin-C and valve were 15.7±3.56 mmHg,15.9±3.47 mmHg and 17.6±2.27 mmHg respectively.When comparing preoperative to 1 year post operative IOP, all the surgeries demonstrated statistically significant reductions in IOP although the magnitude of IOP reduction was greater for valve than trabeculectomy,trabeculectomy with mitomycin-C.Complication profiles differed for each type of glaucoma surgery. There were no intraoperative complications for all glaucoma surgeries. The immediate complication for both trabeculectomy. Trabeculectomy with mitomycin-C was bleb leak (10%) and shallow anterior chamber (10%) while for valve implantation hyphema (20%) predominated. Although complication profiles differ between procedures, all are safe and well tolerated.This study provides support that trabeculetomy, trabeculectomy with mitomycin-C and valve implantation are safe and effective glaucoma surgeries. CONCLUSION All the three surgeries ,glaucoma valve implantation, trabeculectomy, and trabeculectomy with mitomycin-C produce significant reductions in IOP.Although complication profiles differ between procedures, all are safe and well tolerated. This study provides support that trabeculectomy, glaucoma valve implantation and trabeculectomy with mitomycin-C are indeed safe and effective.