Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Steinmaurer, A.
Therapy options after failed trabeculectomy
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Faschinger Christoph
- Mossböck Georg
- Altmetrics:
- Abstract:
- Purpose: After trabeculectomy, too excessive wound healing is unwanted because it increases the conjunctival resistance and therefore causes bleb failure. However, often it cannot be suppressed sufficiently and if bleb failure is refractory to treatment, what means that the failure of primary trabeculectomy is confirmed and irreversible, further treatment options need to be considered. It is the intention behind this essay to discuss and to compare these treatment options for the chronic open-angle glaucoma. However, prior to discussing the treatment options after failed trabeculectomy, the options that are available to target bleb failure should be presented and studied closely. Methods: All the sources that have either been used to develop the basic structure of this essay or to write it are papers or well-known ophthalmologic reference books. The papers that are of high relevance for this topic could have been identified by searching PubMed. Results: Prior to further surgery, it may be useful to restart or to intensify medical treatment and to take advantage of laser interventions. Laser trabeculoplasty or cyclophotocoagulation may be the options of choice. All in all, cyclophotocoagulation has a higher pressure lowering impact, but the complication profile is more severe as well. Further surgery is indicated if glaucoma is refractory to medical and laser treatment or primarily if the surgical approach has been taken. After failed trabeculectomy, all kinds of surgery are still possible, but due to its better safety profile, tube shunt surgery might be beneficial to further trabeculectomy. The different tube shunts appear to have a similar impact on IOP, but the size of the tube shunt does seem to be of importance. The role of mini-tube shunt surgery is still discussed controversially because the extent of its IOP reduction remains unclear, but it seems to be comparable with the one after trabeculectomy. The pressure lowering impact of non-penetrating surgery is considered to be a bit lower than the one of penetrating surgery, but nevertheless, it is a promising intervention, especially due to its great safety profile. Conclusion: Glaucoma therapy is characterised by its very high number of different treatment options and this variety explains why that many treatment strategies are successful. Subsequently, the treatment concept needs to be coordinated with the individual situation and its final success depends on the skills as well as on the professional experience of the treating ophthalmologist.