The Therapeutic Effect Comparison Of Initial Site Filtering Pathway Open Operation With Repeated Trabeculectomy

Purpose:To investigate the outcome after the repeated operation through the initial site of glaucoma filtering surgery,and compare with the secondary trabeculectomy.Methods:12(13 eyes) patients had the blockage in operative filtration pathway after the first trabeculectomy,then took the initial site filtering pathway open operation.Compare with the 19(22 eyes) patients who took the secondary trabeculectomy in the same period.Checked up the situation of iridal openings and filtering blebs with slit lamp microscope and gonioscope.The reason of first operating failure was blockage in external pathway.The surgeon was the same one of the first trabeculectomy,the initial site filtering pathway open operation and the secondary trabeculectomy.Using intraocular pressure(IOP) reducing drugs,so the IOP of pre-operation was lower than 40mmHg.The intraocular pressure(IOP) examination and the Kronfeld Grading Scale were followed after the repeated operation.Analyzed blebs survival of the two teams with Kaplan-Meier survival analysis.Results:(1) The mean IOP of post-operation:7 days after the reconstruction surgery,the mean IOP (13.77+4.71mmHg) was lower than that of the pre-operation (28.15±7.54mmHg) (P<0.001),and 7 days after the secondary trabeculectomy,the mean IOP (15.05±4.36mmHg) was lower than that of the pre-operation (25.36±8.89mmHg) (P<0.001).The last checking after the reconstruction surgery,the mean IOP was 17.38±10.50mmHg,and the last checking after the secondary trabeculectomy,the mean IOP was 16.00±11.08mmHg.There was no statistical difference between the two teams (P>0.05).(2)The form and function of blebs:7 days after surgery,the filtering blebs morphology were low or moderate elevation, extensive,and mild vascularity in two teams.The last checking after surgery,there were 10(11 eyes) functional blebs and 2(2 eyes) unfunctional blebs in reconstruction surgery team,17(20 eyes) functional blebs and 2(2 eyes) unfunctional blebs in secondary trabeculectomy team.There was no statistical difference between the two teams with Kaplan-Meier survival analysis (P>0.05). (3) There was no surgical complication of all the patients.Conclusions:(1) Comparison with secondary trabeculectomy,a repeated surgery through the initial surgical site also can control IOP,the form and function is well. (2) A repeated surgery through the initial surgical site may be a good choice for the failure trabeculectomy.For some advantages,fewer complications,less destruction to the normal tissue,smaller scar and so on.The most importance is that,the effect to control IOP is obvious. (3) The initial site filtering pathway open operation and the first trabeculectomy should be done with the same surgeon,that will be safer and more practical.