The Study On The Improved Trabeculectomy With Electrocautery In Animal And Clinic

Objective1. To evaluate the role of electrocautery on the scleral bed after trabeculectomy by observing the scarring process of the filtering site after surgery in rabbits’ pathological section.2. To determine whether phacotrabeculectomy combined with electrocautery on the filtering site can aid filtration in clinical study.Methods1. Trabeculectomy combined with ECT or MMC was randomly performed on one of eyes of12healthy adult rabbits. Trabeculectomy was performed on another3healthy adult rabbits. Tissues were harvested from the bleb area and made into pathological section statedly.2. Fifty-nine patients with coexisting cataract and uncontrolled glaucoma were randomized to ECT or MMC phacotrabeculectomy and reviewed with a follow-up at one year. All the data were analysed by the SPSS16.0statistical soft ware Package.Results1. There was no statistical difference between the ECT and the MMC groups in the degree of conjunctival congestion, the anterior chamber of reaction and the formation of functional filtering blebs after the surgery of rabbits (P>0.05). In both groups, one had post-operative slight hyphema in the anterior chamber; in the MMC group, one had exudation in the anterior chamber.2. On postoperative day1,3,7, both groups of rabbits were significant improvement in IOP (P<0.05). On postoperative day14,28, there was no statistically significant difference in intraocular pressure decrease between the two groups (P<0.05)3. When observed on the7day after surgery, the sclera filtering site was much more obvious in both of the ECT and MMC groups than those of control group. On postoperative14th day, all the sclera filtering site of three groups were closed. The scar formation of the filtering bleb were obvious in the28th day in rabbits.4. There was no statistical difference between the ECT and the MMC groups in the formation of functional filtering blebs (x2=0.056, P>0.05) and BCVA (Z=-1.000, P=0.710) after the surgery. Early mild corneal edema was observed in both groups (5eyes in the ECT group,6eyes in the MMC group). In the ECT group, one had post-operative exudation in the anterior chamber; in the MMC group, one had slight hyphema and one eye had exudation in the anterior chamber.5. In the ECT group, the IOP decreased from27.0±6.2mmHg before surgery to14.6±2.2mmHg at the final examination (P=0.000). In the MMC group, the IOP decreased from28.6±7.1mmHg before surgery to14.2±3.7mmHg at the final examination (P=0.000). Moreover, there was no statistically significant difference in intraocular pressure decrease between the two groups (P=0.109). The MD and PSD value was not diferent at post/preoperation between group ECT and group MMC respectively (P>0.05).6. The filtering sites of all the patients in both groups could be detected by ultrasound biomicroscopy at1,3,6,12month after surgery.Conlusions1. Trabeculectomy combined with ECT could postpone the scar formation of the filtering site certified by pathological section in rabbits’study.2. Electrocautery could get comparable outcome as MMC in phacotrabeculectomy with few complications in clinical study.3. The safety and efficacy of the improved phacotrabeculectomy with electrocautery (ECT) was certified by our study, but the mechanism for preventing scar formation still need furtuer study.