Trabeculectomy: a retrospective follow-up of 700 eyes

A major focus of our study was to determine the value of postoperative intr aocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). Th e medical charts of 547 patients undergoing glaucoma filtering surgery at t he Department of Ophthalmology of the University of Cologne from 1987 to 19 96 were reviewed. The status of the visual field, level of visual acuity, a ppearance of the bleb, cup/disc ratio and IOP were studied. Pre- and post-o perative glaucoma medication was recorded. The eyes with congenital glaucom a and those treated with anti-metabolites were excluded. The results are pr esented with particular emphasis being placed not only on intraocular press ure (IOP) control but also on the progression of glaucomatous damage (deter ioration of visual field or disc damage) and the decrease of visual acuity. The tonometric success rate of TE in controlling the IOP < 21 mmHg was 61% . Defining the rigid criteria for success of trabeculectomy as an IOP < 21 mmHg, no further visual field loss, no disc damage and no additionally requ ired surgical intervention due to glaucoma, the success rate decreased to 4 4%. The results indicate that other factors than normalization of IOP deter mine the success rate of TE. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? Should trabeculectomy fail to contro l the IOP in the first eye, would this allow options, such as the use of an timetabolites in the second eye?