Nachbetreuung von Trabekulektomien Komplikationen und therapeutische Konsequenzen

Background Intensive follow-up after trabeculectomy is important for long-term success. In the postoperative period, complications must be detected early in order to initiate adequate therapeutic measures. Patients and methods. In a retrospective study 113 eyes from 113 consecutive patients were followed-up for a perioc of 6 months after trabeculectomy with regard to postoperative complications and therapeutic decisions (invasive and conservative). Criteria of success were defined as an intraocular pressure (IOP) 20% compared to the preoperatively treated IOP. Results. Most of the postoperative complications occurred within the first 3 weeks: scarring of the filtering bleb (47.6%), choroidal detachment (18.6%), shallowing ofthe anterior chamber (8%), fibrinous reaction (5.3%), overfiltration (4.4%), reduced flow under the scleral flap (4.4%), corneal dellen (3.5%), prolapse of the iris (3.5%), external fistulation (2.7%),increase of the IOP due to steroids (1.8%), detachment of the ciliary body (1.8%) and malignant glaucoma (0.9%). In the postoperative period, 45.1% of the eyes needed further interventions such as 5-fluorouracil (5-FU) injections (28.3%), needling and 5-FU-injections (14.2%), laser suturolysis (6.2%). Repositioning of the iris, YAG-laser iridotomy, laser treatment of the filtering bleb, autologous blood injection and cyclocryoapplication were needed only in rare cases and 36.3% received other conservative treatment (i.e. modification of topical steroids, increase of cycloplegic treatment). After 6 months the success rate without antiglaucoma medication was 88.5%. Conclusions. An intensive follow-up after trabeculectomy is mandatory to avoid postoperative failure. In about half of the patients postoperative additional therapeutic measures became necessary, particularly if scarring of the filtering bleb occurred. Paying attention to these factors yields in a high success rate after filtering surgery.