الفهرس 
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Abstract
Since the late 1960s, trabeculectomy has been the operation of choice for improving aqueous outflow in glaucomatous eyes and is still regarded as the gold standard to which the newer operations are compared. The long-term successful control of intraocular pressure in eyes that have undergone primary trabeculectomy has ranged from 48 to 98%, depending on follow-up time and the criteria used to define successful outcome. In most studies, postoperative complete success in terms of IOP has been described as an IOP of 21 mmHg or less, without medication (61-68).
In our study, we have described the incidence of surgical complications which was reported during and within the first postoperative 3month after trabeculectomy surgery done in Suez Canal University hospital in one year, (from 1/6/2011 to 30/5/2012).
Edmunds and his colleges, 2002(69) reported complications of first-time trabeculectomy from a nationally representative cohort of patients with chronic open angle glaucoma, Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n = 304, 24.6%), shallow anterior chamber (n = 296, 23.9%), hypotony (n = 296, 24.3%), wound leak (n = 216, 17.8%) and choroidal detachment (n = 175, 14.1%). The most frequent late complications were cataract (n = 251, 20.2%), decreased visual acuity more than two lines (n = 230, 18.8%) and encapsulated bleb (n = 42, 3.4%); while in our study early complications were reported in 60% of cases and also some cases had more than one complication. Hyphaema rate was reported in 15% (3eyes). Shallow AC reported in 20% (4 eyes). Cataract reported in 10% (2eyes). And lost bleb reported in 10% (2eyes). No choroidal detachment was reported.
Edmunds and his colleges, (69) concluded that this survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level.
Jampel and his colleges, 2005(70) described the incidence of surgical complications reported during and within the first post-operative month after trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). 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; while in our study the only intraoperative complication was anterior chamber bleeding with nearly double the percentage of Jampel HD(70) study (15%, 3 eyes),and in our study the rate of post operative complications was (60%).
Jampel and his colleges (70) concluded that 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.
Mills, 1982(71) reported the results of surgical procedure of trabeculectomy, as performed by the staff of the Manchester Royal Eye hospital from 1974 to 1979 inclusive on 356 patients (444 eyes), with particular emphasis not only on intraocular pressure control but on post operative short and long term complications. Decreased visual acuity more than two lines was the most frequent (66eyes, 15.2%), shallow or flat anterior chamber (57 eyes, 13.1%), hyphaema (30 eyes, 6.9%), choroidal detachment (23 eyes, 5.3%); while in our study decreased visual acuity more than two lines also was the most frequent complication, reported in 25% (5eyes), followed by blebitis and flat or shallow AC 20% (4 eyes ) each. Followed by hyphaema 15% (3 eyes), followed by lost bleb and cataract formation 10% (2eyes) each.
Mills (71) concluded that although trabeculectomy represents an important surgical advance (from previous fistulising procedures) in the treatment of glaucoma, it remains a procedure with significant and serious complications.
Jagdish Bhatia, 2008(72) designed a study to evaluate the short term outcome of trabeculectomy retrospectively in a series of cases of Primary Open Angle Glaucoma (PAOG) that had undergone successful primary trabeculectomy by a conventional technique without antimetabolites. While in our study glaucoma cases were of three types, primary open angle glaucoma (POAG) 13 eyes (65%), congenital glaucoma 5 eyes (25%) and closed angle glaucoma 2 eyes (10%). And in our study an antimetabolite agent (mitomycin c) was used in 5 eyes (25%).
Jagdish Bhatia (72) also reported that the tonometric success rate of trabeculectomy in controlling the IOP at 21mmHg or less without any medication was 46%, Post operative IOP 21 mmHg or less with one topical medication was 18%, while 36% trabeculectomies failed to show desired results. While in our study, controlling the IOP at 21 mmHg or less without any medication had been shown in 55% (11eyes), Post operative IOP 21 mmHg or less with one topical medication in 20% (5eyes), Post operative IOP 21 mmHg or less with two topical medication in 15% (3eyes), Post operative IOP 21 mmHg or less with three topical medication in 5% (one eye) and in 5% (one eye) trabeculectomy failed to show desired results. The mean pre-operative IOP was 37.80 with ±13.20 standard deviation (SD), mean postoperative IOP(after three month) was 14.20 with SD ± 2.48.
Jagdish Bhatia (72) concluded that the procedure of trabeculectomy has moderate success in controlling the intra ocular pressure in the study population.
Our study can be considered small in size however, this is due to the small number of cases we have in our research, and short duration of follow up; this was due to the weakness of the financial and social possibilities for some patients and also returned to the exclusion criteria which we have set before beginning the study
But we have committed ourselves to accuracy and credibility in gathering information and follow-up of cases and analyze what we got from the results to represent a good and realistic reference for other audits.