Perioperative Complications of Trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS)

Jampel, Henry D.; Musch, David C.; Gillespie, Brenda W.; Lichter, Paul R.; Wright, Martha M.; Guire, Kenneth E.; Collaborative Initial Glaucoma Treatment Study Group,

doi:10.1016/j.ajo.2005.02.013

« Previous Next »American Journal of Ophthalmology
Volume 140, Issue 1 , Pages 16-22, July 2005

Perioperative Complications of Trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS)

Henry D. Jampel, MD, MHS
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Inquiries to Henry D. Jampel, MD, MHS, Johns Hopkins Hospital, Wilmer Ophthalmological Institute, Maumenee B-110, 600 North Wolfe Street, Baltimore, MD 21287-9205; fax: (410) 502-7493
David C. Musch, PhD, MPH
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
Brenda W. Gillespie, PhD
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
Paul R. Lichter, MD
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
Martha M. Wright, MD
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota.
Kenneth E. Guire, MS
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
Collaborative Initial Glaucoma Treatment Study Group

Accepted 1 February 2005. published online 06 June 2005.

Purpose

To describe the incidence of, and risk factors for, surgical complications reported during and within the first post-operative month after trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).

Design

Review of prospectively collected data from a multicenter, randomized clinical trial.

Methods

Complications were tabulated for the 300 CIGTS patients randomized to surgery. Logistic regression analyses were used to identify risk factors for complications.

Results

Among the 300 patients randomized to initial surgery, 465 trabeculectomies were performed. Intraoperative complications were reported in 55 eyes (12%). The most frequent reported complications were anterior chamber bleeding during surgery (37 eyes, 8%) and conjunctival buttonhole (five eyes, 1%). Early post-operative complications were reported in 232 eyes (50%). Complications with a frequency over 10% included shallow or flat anterior chamber (62 eyes, 13%), encapsulated bleb (56 eyes, 12%), ptosis (55 eyes, 12%), serous choroidal detachment (52 eyes, 11%), and anterior chamber bleeding or hyphema (48 eyes, 10%). There were three localized suprachoroidal hemorrhages (0.7%) and no cases of endophthalmitis. Older patients were more likely to experience serous choroidal detachment, new anterior or posterior synechiae, and wound leak. Blacks were less likely to experience anterior chamber bleeding, but more likely to experience post-operative ptosis. The number of subjects experiencing bilateral complications was higher than that which would have been predicted by chance alone.

Conclusions

The incidence of transient and self-limiting complications was high in the perioperative period, but we observed few complications with the potential to cause severe sustained vision loss in this group of previously untreated eyes.

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Members of the CIGTS Study Group are listed in the Appendix to Musch DC et al. Ophthalmology 1999;106:653–662.Dr. Jampel is the recipient of a Research to Prevent Blindness Physician-Scientist Award.Supported by National Institutes of Health, Bethesda, Maryland, grants EY09100, EY09140, EY09141, EY09142, EY09143, EY09144, EY09145, EY09148, EY09149, EY09150, and EY09639.