Clinical analysis of compound trabeculectomy for refractory glaucoma

Objective To investigate the clinical efficacy of compound trabeculectomy for refractory glaucoma.Methods A total of 42 refractory glaucoma patients(50 eyes),who were taking compound trabeculectomy,were enrolled,in which were 6 cases(10 eyes) with juvenile developmental glaucoma,5 cases(5 eyes) with secondary glaucoma by ocular contusion,3 cases(3 eyes) with aphakic glaucoma,10 cases(14 eyes) with glaucoma by the failure of filtration surgery,10 cases(10 eyes) with secondary glaucoma by uveitis and 8 cases(8 eyes) with neovascular glaucoma.For achieving functional filtering blebs and ideal intraocular pressure,0.33 g·L-1 mitomycin C was used to inhibit scar formation at filtration areas,adjustable suture at sclera flap and anterior chamber injection were used to control shallow of anterior chamber at postoperative early time.Patients with secondary glaucoma by uveitis were treated with anti-inflammatory treatment according to etiopathogenesis.For 8 cases(8 eyes) with neovascular glaucoma,there were 4 cases(4 eyes) by central retinal vein occlusion,3 cases(3 eyes) by diabetic retinopathy and 1 case(1 eye) by high intraocular pressure with a long time;The former two types were treated with laser retinal photocoagulation postoperatively.Results The average intraocular pressure were (10.07±2.38)mmHg(1 kPa=7.5 mmHg),(14.30±2.73)mmHg at postoperative 1 week,6 months,which had statistical difference compared with(35.00±5.58) mmHg preoperatively and after taking drugs(both P0.05).All patients were followed up for 6 months to 24 months.The operative successful rate was 92%,in which 45 eyes(90%) were with complete success,1 eye(2%) with success at certain condition and 4 eyes(8%) with failure.Filtering blebs of 4 eyes(8%) were in type Ⅰ,42 eyes(84%) in typeⅡ,3 eyes(6%) in type Ⅲ and 1 eye(2%) in type Ⅳ;The type Ⅰ and type Ⅱ were functional filtering blebs.Best corrected visual acuity improved be and more than 2 lines was in 5 eyes,unchanged in 4 eyes and decreased 2 lines in 1 eye.Visual field enlarged in 5 eyes,unchanged or be without obvious decrease in others.Hyphema was in 8 cases(8 eyes) postoperatively,and absorbed after drug treatment for 3 days to 5 days.There were 3 eyes with exudative reaction,and resolved after drug treatment;There was 1 eye with detachment of choroid,and recovered after drug treatment.There was not filtering blebs leakage,persistent hypertension or macular edema.Conclusions Compound trabeculectomy is with high successful rate and less complications for refractory glaucoma.It should be combined with early eyeball massage and taking treatment according to etiopathogene for achieving better curative efficacy.