Long-term Safety and Outcomes of β-radiation for Trabeculectomy.

PRCIS: Beta-radiation is a neglected anti-scaring therapy with past concerns for safety. This report found it safe and efficacious when used as an adjuvant to trabeculectomy surgery in 101 people (135 eyes) over 20 years.

PURPOSE: Beta-radiation has been used as an adjunct to prevent scarring in trabeculectomy surgery for many decades. Safety concerns were raised with the use of high doses on bare sclera. Moorfields Eye Hospital has a large cohort of patients who have received beta-radiation therapy. We report a review of the long-term safety and efficacy.

METHODS: Cases undertaken between August 1992 and August 1996 were reviewed. Those with records available for postoperative review more than 5 years were included. Failure (reintervention/>21 mmHg on 2 successive occasions) and any complication previously reported in association with β-radiation were the primary outcomes.

RESULTS: In total, 292 operations using β-radiation were recorded and 101 people (135 eyes) with trabeculectomy surgery and post-operative follow-up for over 4.5 years were included. The median follow-up period was 22.5 years. At final follow-up 50 (48%) eyes had failed and 20/51 (51%) eyes with primary open angle glaucoma had had cataract surgery. Other complications were rare and associated with co-pathology.

CONCLUSION: In glaucoma patients at risk of scarring and failure after trabeculectomy, as an anti-scarring adjuvant, a 750cGY dose of beta radiation was found to be safe and efficacious in the long-term.