Early leaks potential indicator for trabeculectomy failure

MIAMI — An early postoperative wound leak is a risk factor for trabeculectomy failure, surgeons with Bascom Palmer Eye Institute have found. They recommend that trabeculectomy be performed in a superior location with a two-layer closure to decrease the risk of failure.

The Fluorouracil Filtering Surgery Study Group analyzed 213 patients with previous cataract surgery or failed filtering surgery who were randomized to either trabeculectomy or trabeculectomy with postop subconjunctival 5-fluorouracil (5-FU) injections. Failure was defined as a reoperation to control IOP or an IOP greater than 21 mm Hg with or without medication at or after the 1-year postop follow-up. Early leaks were defined as developing within 2 weeks postop. Follow-up lasted 5 years.

At 1 year postop, the success rate for the 5-FU group was 80% in eyes without a leak and 60% in eyes with a leak. After 5 years, the success rate with 5-FU fell to 54% in eyes without a leak and to 28% in eyes with a leak. The 1-year postop success rate in the trabeculectomy-only group was 50% in eyes without a leak and 44% in eyes with a leak. After 5 years, the success rate for trabeculectomy-only fell to 24% in eyes without a leak and to 15% in eyes with a leak.

Leaks were more common in the 5-FU group (32%) than in the standard group (20%). More eyes with one-layer conjunctiva-Tenon’s capsule closure developed leaks than those with two layer closure (P = .006). When the trabeculectomy was located inferiorly, 29 of 76 eyes developed leaks compared with 27 of 137 eyes that developed leaks when the trabeculectomy was located superiorly.

The study is published in the American Journal of Ophthalmology.