Trabeculectomy with scleral tunnel treating refractory glaucoma

Objective To investigate the clinical effecl of trabeculectomy with scleral tunnel in the treatment of refractory glaucoma. Design Prospective, randomized and comparative clinical study. Participants 87 patients (98 eyes) with refractory glaucoma. Methods The patients were randomly assigned to receiving trabeculectomy with or without scleral tunnel. The tunnel group (50 eyes) underwent trabeculectomy with an additional deep scleral tunnel of 5.0mm×1.5mm beneath the superficial scleral flap. The control group (48 eyes) underwent conventional trabeculectomy. The average follow-up period was 6 to 12 months posloperatively. Main Outcome Measures Visual acuity, intraocular pressures (IOP), filtering blebs, operative and postoperative complications. Results (1) No significant differences in visual acuity were found between two groups. (2) The postoperative IOPs were significantly lower than the preoperative IOPs in both groups, while the IOPs on the 7th day after the surgery between the two groups were not different significantly. The average postoperative IOP at the 6th month in the tunnel group was 14.34±3.95 mmHg and 19.57±7.76 mmHg in the control group, which were different significantly (P0.05). The successful rates were 88.00% and 64.58% in two groups respectively. (3) The percentage of functional filtering blebs in the funnel group was 82.0%, significantly higher than that of 60.4% in the control group (P0.05). (4) The incidence rate of shallow anterior chamber in the tunnel group was higher than that in the control group, but all the cases had recovered by the end of 1 week after proper treatment. There were no relative complications. Conclusion The trabeculectomy with scleral tunnel has the advantages of preventing postoperative scar formation and achieving better control of postoperative IOP over the conventional trabeculectomy in treating refractory glaucoma.