Optimizing Outcomes

Optimizing Outcomes

Until today, trabeculectomy remains the most effective method for

long-term lowering of intraocular pressure (IOP) Optimizing Outcomes.

However, the procedure poses some early and late onset complications.

Dr. Naveed Nilforushan from the Iran University of Medical Sciences shared some considerations that could make trabeculectomy safer and more effective. According to

Dr. Nilforushan, patient selection is the most important predictor of outcome in trabeculectomy.

 “A person who often travels to remote areas without access to medical care, or one who engages in water-based sports, or uses contact lenses, isn’t a good candidate for this surgery,” he said.

Other risk factors for failure or complication include multiple prior surgeries, uncontrolled uveitis, dry eye, inflamed ลาวสามัคคี วีไอพี

and thin conjunctiva, angleclosure glaucoma and high hyperopia, uncontrolled diabetes, high blood pressure and clotting disorders.

A history of a bad outcome after filtration surgery in the fellow eye should also be taken seriously.

 “All lid problems, such as trichiasis, entropion and blepharitis should be treated before the surgery.

 If there is a conjunctival injection, the patient should

be given a short preoperative course of topical steroids Optimizing Outcomes.

It is also very important to control the IOP as much as possible before starting the surgery. “Surgical success is highly related to regular and timely follow-ups.

The goals are to monitor for complications and identify factors that may jeopardize long-term bleb function.

Most early complications are transient, and serious complications like choroidal hemorrhage are fortunately rare,” said Dr. Nilforushan.

According to him, late complications like thin avascular blebs, leakage, blebitis and hypotonia are more commonly due to prolonged inhibition of fibroblasts by mitomycin-C (MMC).

 In high-risk patients, alternatives which can be used include collagen matrix (Ologen; Aeon Astron Europe B.V., the Netherlands) and Avastin (Genentech, California, USA).

“To achieve IOP in the low teens, it’s important to make a thinner and smaller scleral flap, and a larger ostium,

and use higher dosages and/or longer duration of MMC application, as well as removing the flap suture earlier.

Blebs that show signs of encapsulation or failure can be treated more aggressively with additional

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