Objective or Purpose Better early postoperative intraocular pressure (IOP) is of great importance that guarantees prolonged therapeutic effects of trabeculectomy. The current trial is to evaluate the effectiveness of adjusting IOP immediately after an intraoperative IOP test on controlling the early postoperative IOP.
Participants and methods Patients with primary angle-closure glaucoma (PACG) and open angle glaucoma (POAG) received a comprehensive eye examination prior to antimetabolite augmented trabeculectomy. The scleral flap was sutured to allow “equilibrium” or flow on gentle pressure. The IOP was measured (Tono-Pen®, Reichert Technologies, USA) 3 minutes after the closure of scleral flap with a formed anterior chamber. Participants were randomized into arm A (if IOP >12, then adjust the suture tension to achieve IOP ≤ 12mm Hg) or arm B (intraoperative IOP was recorded without informing the surgeon, no IOP-guided adjustment). Post operative examinations at days 1, 7 and 90 included measurements of IOP and recording of complications.
Results 33 participants (33 eyes) were included. The mean age was 62.3±7.6 years and 48.5% of them were males. 28 (84.4%) patients had PACG. The mean deviation (MD) of visual field defects was -15.6±9.9dB. The preoperative IOP was 28.7±5.9mm Hg. The number of patients followed up at days 1, 7 and 90 was 33, 33 and 11.
No Significant differences between arm A (n=16) and B (n=17) were found for age, baseline IOP, visual filed MD, the proportion of females and PACG (P>0.05).Means intraoperative IOP for arm A and B were 9.7±2.5mm Hg (after adjustment) and 13.7±4.2mm Hg (P=0.003). IOP measured on days 1, 7 and 90 was 9.1±2.7 mm Hg, 10.1±3.1 mm Hg and 12.0±1.6mm Hg in the arm A, and, was 11.4±5.6 mm Hg, 11.6±4.1 mm Hg and 15.7±3.1 mm Hg in arm B. Significant differences between the two arms were found for every follow up points.
There were 3 cases of transient shallow anterior chamber (SAC) and 1 case of scaring bleb needed intervention during the first 7 days. All of the complications were handled. No other complication was observed. Both arms had the same probability in developing a SAC (P=0.89).
Conclusions Our preliminary results suggested adjusting intraoperative IOP after the closure of scleral flap with a formed anterior chamber during trabeculectomy may have a notable benefit on controlling postoperative IOP.