**3. Surgical procedure**

(37.5 %) received laser suture lysis,6 patients (15.0 %) underwent needling proce‐ dure, and 3 patients (7.5 %) underwent additional surgery, although no patient in the trabeculotomy group received postoperative intervention except for topical medical treatment. In the trabeculotomy group, patients with higher preoperative intraocular pressure showed a significantly higher intraocular pressure at 12 months postoperatively (P < 0.0001), although there was no significant correlation

**Conclusions:** There was no significant difference in hypotensive efficacy between patients undergoing trabeculotomyaugmented by postoperative topical medica‐ tions and those undergoing trabeculectomyaugmented by Mitomycin Cat 12 months. In those receiving trabeculotomy, patients with higher preoperative intra‐ ocular pressure showed a significantly higher intraocular pressure at 12 months

Trabeculectomy has been a standard procedure for medically uncontrollable glaucoma [1]. Serious postoperative complications are not infrequently associated with trabeculectomy [2-5]. These include flat anterior chamber, hypotony and choroidal detachment caused by overfil‐ tration, late-onset bleb-related complications, including endophthalmitis, and cataract progression. Shigeeda et al. demonstrated that 44.5% of patients who had undergone trabe‐ culectomy augmented with mitomycin C showed a success defined as an intraocular pressure of less than 16 mm Hg after 8 years [6]. However, Tanihara et al. demonstrated that medical treatment following trabeculotomy provided an additional intraocular pressure reduction and that this surgery produced long-term stability of intraocular pressure control [7]. Trabeculot‐ omy infrequently causes serious complications and seldom requires additional postoperative interventions [8, 9]. The aim of this study is to study the safety and hypotensive effect of trabeculotomy augmented by postoperative medical treatment in patients with open-angle

In a non-randomized consecutive case series, we studied 82 patients with open-angle glaucoma who underwent trabeculotomy augmented by postoperative medical therapy or trabeculec‐ tomy augmented with mitomycin C. A diagnosis of glaucoma was on the gonioscopic finding along with appearance of the optic nerve head cupping and visual alteration according to the guideline of Japan Glaucoma Society [10]. Excluded were patients with angle-closure glauco‐

**Keywords:** trabeculotomy, trabeculectomy, postoperative medication

glaucoma and to compare with trabeculectomy augmented by mitomycin C.

between them in the trabeculectomy group.

even though less than 20 mmHg.

**1. Introduction**

92 Advances in Eye Surgery

**2. Patients and methods**

**Trabeculectomy:** All surgeries were performed by a single surgeon. A modified Cairns-type technique was performed [1]. After making a fornix-based conjunctival flap and dissecting a limbus-based 4 x 4-mm scleral flap, mitomycin C 0.04%-soaked sponges were placed under‐ neath the conjunctival flap for 3 minutes. Afterward, 250 ml of balanced salt solution (Balanced Salt Solution Plus™; Alcon, Fort Worth, TX, USA) was used to wash the surgical area. Paracentesis was carried out followed by a peripheral iridectomy. A scleral flap was sutured with 10/0 nylon, and a conjunctival flap was also sutured with 10/0 nylon with wing stretch technique.

If the bleb was flat or the intraocular pressure was not low enough, laser suture lysis was carried out. If the bleb became flat or localized, needling with angled V-lance was carried out.

**Trabeculotomy:** After making a fornix-based conjunctival flap, a 4 x 4-mm 4/5 thickness limbus-based scleral flap was created. The outer wall of the Schlemm's canal was incised and removed. The Nagata's semicircular trabeculotome probe was inserted into the Schlemm's canal, and an ocular viscoelastic device (Healon 1%™, Abbott Medical Optics, Santana, CA, USA) was filled in the anterior chamber to reduce postoperative hyphema. The trabeculotome was in-rotated to disrupt the inner wall of the canal, and the viscoelastic material was manually replaced with balanced salt solution. The scleral flap was then sutured watertight with seven 10/0 nylon sutures.
