VV 59Intensified postoperative management may enhance the success rates of viscocanalostomy
Introduction: Lower rates of postoperative complications and simplified postoperative management seem to be the major advantages of viscocanalostomy compared to trabeculectomy. However, several studies show that the average intraocular pressures remain higher following viscocanalostomy than trabeculectomy. The success rates of viscocanalostomy in Caucasian patients with chronic glaucoma may be increased by an intensified postoperative management.
Methods: 50 eyes of patients with advanced glaucoma (including complicated glaucoma with neovascularisation, uveitis, aphakia, or ocular pemphigoid and with 1.5+0.8 previous operations) underwent classic viscocanalostomy. The postoperative follow-up comprised 12+5 months. In analogy to current follow-up schemes after trabeculectomy, the surgeon meticulously monitored the postoperative status. In addition to intensive topical antiinflammatory treatment (prednisolone acetate 1 % qhs), subconjunctival injections of 5-fluoruracil were given as needed.
Results: The intraocular pressure dropped from an average of 30.5+6.9 mm Hg to 16.5+7.1 mm postoperatively. The amount of antiglaucoma-drugs decreased from 2,4 to 0.4; more than 80 % of eyes did not need any topical medication to reach their target pressures of maximally 19 mm Hg.
Conclusion: Viscocanalostomy combined with an intensive postoperative follow-up may succeed in reducing the intraocular pressure to 55 % of preoperative values without medication in patients with severe and chronic glaucoma.
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