Tolga KOCATÜRK, Sinan BEKMEZ, Harun ÇAKMAK, Volkan DAYANIR

Trabekülektomi Komplikasyonları

Glokom, ilerleyici optik atrofi ve görme alanı kaybı ile karakterize, kronik iskemik optik nöropatidir. Yüksek göz içi basıncı (GİB) en önemli risk faktörlerinden biridir. Tedavide GİB'i düşürmek amaçlanır. GİB'i düşürmeye yönelik tedavi yöntemleri; medikal tedavi, lazer tedavisi ve cerrahi tedavi olarak üç gruba ayrılır. Penetran glokom cerrahisi, maksimum tolere edilebilen medikal tedaviye rağmen kontrolsuz yüksek GİB olması nedeniyle ya da başarısız lazer trabeküloplasti sonrası uygulanmaktadır. Cerrahiyi geciktirmenin ana sebebi özellikle yüksek risk grubunda görülen yüksek başarısızlık oranları ile ilişkili postoperatif komplikasyon riskidir. Buna rağmen yeni gelişmeler ile daha güvenli ve başarılı cerrahiler yapılmaktadır. Trabekülektomi, günümüzde glokomun cerrahi tedavisinde altın standart olma özelliğini korumakta ve GİB'i azaltmak için ülkemizde ve tüm dünyada yaygın olarak uygulanmaktadır. Bu derlemede, trabekülektomi sonrası görülen komplikasyonların, klinik özellikleri ve tedavi seçenekleri güncel literatüre göre tartışılmıştır.

Complications of Trabeculectomy

Glaucoma is a chronic ischemic optic neuropathy characterized by an optic atrophy and progressive visual field loss. High intraocular pressure (IOP) is one of the most important risk factors. The aim of the treatment is to reduce IOP. IOP lowering therapy methods are divided into three groups as medical therapy, laser therapy and surgical treatment. Penetrating glaucoma surgery is applied against uncontrolled high IOP despite the maximum tolerated medical therapy or after a failed laser trabeculoplasty. The main reason for the delay in conventional trabeculectomy is the risk of postoperative complications associated with high failure rate especially in high risk groups. Nevertheless, more secure and successful surgery is made with new advancements. Today, trabeculectomy remains the gold standard in the surgical treatment of glaucoma and is performed widely in our country and all around the world to decrease IOP in refractory glaucoma. In this review, the clinical characteristics and treatment options for complications after trabeculectomy are discussed according to recent literature.

PDF

___

Grehn F, Hollo G, Lachtar Y, Migdal C, Thygesen J, Terminoloji, sınıflandırma ve tanımlar, Giriş Bölümü, Glokom İçin Terminoloji ve Rehber, Traverso CE, eds, 2. Basım, Savona, İtalya, Editrice Dogma®S.r.l., Avrupa Glokom Cemiyeti, 2004, Giriş, 1-4.
Collaborative Normal-Tension Glaucoma Study Group: Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 1998; 126: 487-97.
The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol 2000; 130: 429-40.
Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968; 66: 673-9.
Stalmans I, Gillis A, Lafaut AS, Zeyen T. Safe trabeculectomy technique: long term outcome. Br J Ophthalmol 2006; 90: 44-7.
Palanca-Capistrano AM, Hall J, Cantor LB, Morgan L, Hoop J, WuDunn D. Long-term outcomes of intraoperative 5-fluorouracil versus intraoperative mitomycin C in primary trabeculectomy surgery. Ophthalmology 2009; 116: 185-90.
Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE; Collaborative Initial Glaucoma Treatment Study Group. Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol 2005; 140: 16-22.
Liebmann JM, Ritch R, Complications of glaucoma filtering surgery, Chapter 84, Glaucoma Surgery, Part 7, Glaucoma Therapy, Volume 3, The Glaucomas, 2nd Edition, Ritch R, Shields MB, Krupin T, eds, St. Louis, Mosby-Year Book Inc, 1996, 1703-1736.
Tuli SS, WuDunn D, Ciulla TA, Cantor LB. Delayed suprachoroidal hemorrhage after glaucoma filtration procedures. Ophthalmol 2001; 108: 1808-11.
Jeganathan VSE, Ghosh S, Ruddle JB, Gupta V, Coote MA, Crowston JG. Risk factors for delayed suprachoroidal haemorrhage following glaucoma surgery. Br J Ophthalmol 2008; 92: 1393-6.
Fechtner RD, Minckler D, Weinreb RN, Frangei G, Jampol LM. Complications of glaucoma surgery. Ocular decompression retinopathy. Arch Ophthalmol 1992; 110: 965-8.
Suzuki R, Nakayama M, Satoh N. Three types of retinal bleeding as a complication of hypotony after trabeculectomy. Ophthalmologica 1999; 213: 135-8.
Grunwald JE, Riva CE, Stone RA, Keates EU, Petrig BL. Retinal autoregulation in open-angle glaucoma. Ophthalmology 1984; 91:1690-4.
Minckler DS, Bunt AH. Axoplasmic transport in ocular hypotony and papilledema in the monkey. Arch Ophthalmol 1977; 95: 1430-6.
Shah DP, Krishnan AA, Albanis CV, Dwyer MA, Ernest JT. Visual acuity outcomes following vitreous loss in glaucoma and diabetic patients. Eye (Lond) 2002; 16: 271-4.
Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B. Loss of visual acuity after trabeculectomy. Ophthalmology 1993; 100: 599-612.
DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC. Incidence of lateonset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002; 120: 297-300.
Oyakhire JO, Moroi SE. Clinical and anatomical reversal of longterm hypotony maculopathy. Am J Ophthalmol 2004; 137: 953-5.
Wells AP, Bunce C, Khaw PT. Flap and suture manipulation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery. J Glaucoma 2004; 13: 400-6.
A. von Graefe, "Beitrage zur pathologie und therapie des glaukoms," Archives of Ophthalmology 1869;15:108.
Shaffer RN, Hoskins HD Jr. Ciliary block (malignant) glaucoma. Ophthalmology 1978; 85: 215-21.
Sharma A, Sii F, Shah P, Kirkby GR. Vitrectomy- phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes. Ophthalmology 2006; 113: 1968-73.
Akarsu C, Onol M, Hasanreisoglu B. Postoperative 5-fluorouracil versus intraoperative mitomycin C in high- risk glaucoma filtering surgery:extended follow up. Clin Experiment Ophthalmol 2003; 31: 199-205.
Akarsu C, Önol M, Hasanreisoğlu B. İnce tenon ve konjonktivalı olgularda primer trabekülektominin uzun dönem sonuçları. Turkiye Klinikleri J Ophthalmol 2003; 12: 1-8.
Clarke MP, Vernon SA, Sheldrick JH. The development of cataract following trabeculectomy. Eye (Lond) 1990; 4: 577-83.
Vesti E. Development of cataract after trabeculectomy. Acta Ophthalmol (Copenh) 1993; 71: 777-81.
Quigley HA, Buhrmann RR, West SK, Isseme I, Scudder M, Oliva MS. Long term results of glaucoma surgery among participants in an east African population survey. Br J Ophthalmol 2000; 84: 860-4.
Razzak A, al Samarrai A, Sunba MS. Incidence of posttrabeculectomy cataract among Arabs in Kuwait. Ophthalmic Res 1991; 23: 21-3.
Daugeliene L, Yamamoto T, Kitazawa Y. Cataract development after trabeculectomy with mitomycin C: a 1-year study. Jpn J Ophthalmol 2000; 44: 52-7.
Musch DC, Gillespie BW, Niziol LM, Janz NK, Wren PA, Rockwood EJ, et al; Collaborative Initial Glaucoma Treatment Study Group. Cataract extraction in the Collaborative Initial Glaucoma Treatment Study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Arch Ophthalmol 2006; 124: 1694- 700.
AGIS (Advanced Glaucoma Intervention Study) Investigators. The Advanced Glaucoma Intervention Study, 8: Risk of cataract formation after trabeculectomy. Arch Ophthalmol 2001; 119: 1771-80.
Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III.Early and latecomplications. Eye (Lond) 2002; 16: 297-303.
Karakurt A, Hasıripi H, Sarıkatipoğlu H, ve ark. Primer açık açılı glokomda hastalık evresinin trabekülektomi sonrası göz içi basınç kontrolüne etkisi. TOD XXVIII. Ulusal Kongresi Bülteni. 1994; 1: 236-3.