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Trabeculectomy at the Inferior Limbus
Ronald M. Caronia, MD;
Jeffrey M. Liebmann, MD;
Robert Friedman, MD;
Henry Cohen, MPH;
Robert Ritch, MD
Arch Ophthalmol. 1996;114(4):387-391.
Abstract
Objective
To evaluate intraocular pressure (IOP) control and surgical complications following trabeculectomy with 5-fluorouracil (5-FU) or mitomycin at the inferior limbus.
Methods
The charts of all patients undergoing trabeculectomy at the inferior limbus from July 1984 to March 1993 were reviewed. Surgical success was defined as IOP greater than 4 mm Hg and less than 22 mm Hg and at least a 20% reduction from preoperative IOP.
Patients
All 101 eyes of 101 patients had undergone prior intraocular surgery at the superior limbus. Mean patient age was 57.5±2.0 (±SE) years; mean follow-up was 23.4±2.3 months; mean preoperative IOP was 32.8±0.9 mm Hg; and mean number of preoperative antiglaucoma medications was 2.8±0.1.
Results
Ninety-four eyes (93.1%) received postoperative 5-FU (mean total dose, 36.3±1.7 mg) and seven eyes (6.9%) received intraoperative mitomycin (0.5 mg/mL). Cumulative success for all eyes at 2 and 5 years was 56% and 38%, respectively. Intraocular pressure control without medications was achieved in 39% and 15% of eyes at 2 and 5 years, respectively. Complications included 5-FU epitheliopathy (34.0% of eyes receiving 5-FU), early wound leak (26.7%), choroidal effusion (25.7%), late bleb leak (12.9%), and late bleb-related endophthalmitis (11.9%).
Conclusion
Although trabeculectomy at the inferior limbus offers the opportunity for surgical success in eyes at high risk of failure, this procedure carries an increased risk for late complications and should be reserved for cases in which the therapeutic options are extremely limited.
Author Affiliations
From the Departments of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY and New York Medical College, Valhalla, NY (Drs Caronia, Liebmann, Friedman, and Ritch); Fort Lauderdale Eye Institute, Sunrise, Fla (Dr Friedman); and the Laboratory of Epidemiology and Biostatistics, Department of Environmental Medicine, New York University School of Medicine, New York, NY (Mr Cohen).
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