Early wound leak does not affect trabeculectomy outcomes, study finds

Early postoperative wound leakage after trabeculectomy does not affect surgical outcomes, according to researchers in England.

H.W.A. Henderson and colleagues at Moorfields Eye Hospital in London performed a prospective, observational case series of sequential trabeculectomies over the course of 12 months to assess wound leakage and its effects on outcomes. A fornix-based conjunctival flap was used in 254 cases and a limbus-based flap was used in 41 cases. At each postop visit, the trabeculectomies were rated at one of four levels of leakage: none, mild, moderate or severe. The filters were also assessed for success or failure at 6-month follow-up.

Of the 286 trabeculectomies, 169 (59%) showed leakage at some postoperative point. Of the 245 with fornix-based flaps, 159 (65%) leaked, compared to 10 of the 41 with limbus-based flaps (24%). The median leak time was 3.5 days, with a range of 0 to 408 days. The mean leakage duration was 14 days. A total of 14 trabeculectomies failed completely. Another 40 (14%) were a partial failure.

In 117 cases with no postoperative leakage there was partial or complete failure of the filter in 23 (20%). In 169 cases where leakage occurred, there was partial or complete failure of the filter in 31 (18%).

Cross-tabulation of failure with leakage showed no evidence of an adverse effect of leakage on outcome.

The study is published in the May issue of British Journal of Ophthalmology.