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[Efficacy and complications of a mini-trabeculectomy technique].

OBJECTIVE
To assess the outcome and the complication rate of an adjustable mini-trabeculectomy in medically uncontrolled glaucoma.


PATIENTS AND METHODS
This study retrospectively evaluated the medical records of 40 patients undergoing primary mini-trabeculectomy. All patients were followed at least 24 months, with a mean follow-up of 60.85 +/- 37.7 months. Visual acuity, intraocular pressure (IOP), visual field (MD, Humphrey), number of antiglaucoma medications, intra- and postoperative complications, postoperative procedures (laser suture lysis, 5-fluorouracil subconjunctival injections, or a new trabeculectomy) were analyzed.


RESULTS
Preoperative IOP was 23.2 +/- 6.48 mmHg (range, 13-53 mmHg) with 2.42 +/- 0.74 (range, 1-4) antiglaucoma medications. At last examination, after 60.85 +/- 37.7 months (mean +/- standard deviation; minimum 24 months) of postoperative follow-up, IOP was 12.55 +/- 2.12 mmHg with 0.42 +/- 0.78 antiglaucoma medications (p<0.001 compared to preoperative IOP and p<0.001 compared to the number of medications); 85% and 92.5% of patients had IOP reduced by 30% or more and a final IOP less than 16 mmHg with or without antiglaucoma medications, respectively, and 52.5% had one or more scleral flap sutures released by laser. Postoperative complications were infrequent: flat anterior chamber with choroidal detachment (2.5%) and iris incarceration in the trabeculectomy site (2.5%). Seven patients had an encapsulation of the filtering bleb (17.5%) after a mean follow-up of 34.33 +/- 33 days after surgery. Four patients (10%) had cataract surgery during the 2 years following trabeculectomy. A significant decrease in visual acuity was observed after surgery (p=0.018); nevertheless, there was no statistically significant difference between preoperative and postoperative MD (-10.46+/-9.37 dB and -10.65+/-4.36 dB, respectively; p=0.971, for 23 patients).


CONCLUSION
Adjustable mini-trabeculectomy controlled postoperative filtration. Easy to perform, this surgical technique seemed to be safe and effective, and it reduced the rate of early postoperative complications in the surgical management of patients with glaucoma.