Long‐term outcome of trabeculectomy in terms of intraocular pressure

Abstract

ABSTRACT. Purpose: To evaluate the outcome, long-term results and contributing prognostic factors of trabeculectomy in terms of intraocular pressure (IOP) and to compare the results in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG).Methods: This study involved retrospective evaluation of 138 consecutive patients (138 eyes) with either POAG or EG. All patients had undergone primary trabeculectomy performed by the same surgeon between November 1994 and August 1996. Only one eye per patient was included. Operations performed with the use of antimetabolites were excluded. All patients were aged over 40 years and were white. Follow-up for all subjects lasted at least 2 years. Successful control of IOP was defined as achieving IOP Յ 21 mmHg without medication (complete success) or with a single topical medication (qualified success). Success rates were determined using the Kaplan-Meier survival curve, and risk factors were analysed with proportional hazards regression. Results: According to the Kaplan-Meier survival curve, success rates (complete or qualified) were 82% at 1 year, 70% at 2 years, 64% at 3 years and 52% at 4 years. A total of 63% were complete successes at 1 year, 54% at 2 years, 45% at 3 years and 40% at 4 years. Complete success rates were significantly better in the POAG group than in the EG group. Proportional hazards regression analysis showed that the presence of EG and early postoperative IOP Ͼ 30 mmHg decreased the possibility of complete success, while a cataract operation performed during follow-up improved it. Conclusion: The IOP-reducing effect of trabeculectomy decreases gradually. After 4 years, 52% of operated eyes had IOP Յ 21 mmHg with or without a single topical medication. Diagnosis of EG implied a worse long-term outcome for trabeculectomy in terms of IOP.

The Outcome of Trabeculectomy Surgery among Patients at University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia

“…The previous study conducted in 1999, which found similar IOP-lowering effect in 30 eyes with PXG and 30 eyes with POAG during a follow-up period of 2 years reported the similar finding with present study [16]. However, the finding from studies published in 2002 and 2013 reported that complete success rates were significantly better in the POAG group than in the PXG group [12,17]. There were no a clear reasons why this discrepancy was happens.…”

“…In comparison with two different studies which utilize similar criteria with the present study, this amount of overall success rate in the present study is better [9,10]. However in comparison to three studies with success rates of 88%, 85% and 82%, the current result is lower [11][12][13]. The Trabeculectomy failure found in this study was 8 (11.6%).…”

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

“…[20][21][22][23] Studies on Asian patients in South East Asia have also reported a lower success rate of trabeculectomy than the success rate reported on Caucasian populations in the western literature. 10,11,16 However, the survival of trabeculectomy improved with use of intraoperative antimetabolite as adjuvant, and the more liberal use of intraoperative antimetabolites was advocated in the Asian population. 11,12 Comparisons of survival of trabeculectomy performed in different populations were limited by the different clinical settings in various countries, such as surgical techniques, length of follow-up, and criteria for success.…”

“…From the studies conducted on overseas Asians with POAG, the success rate of trabeculectomy without use of antimetabolite appears to be lower than the success rate in Caucasian. 10,11,16 Wong et al reported a 3-year success rate of only 36% for trabeculectomy in Asians with POAG, but the rate was higher if antimetabolite was used and approached the rate observed in Caucasians reported in the western studies. 12,[16][17][18][19][20] However, comparison of glaucoma surgical management in Asian and Caucasian populations is difficult because of the different surgical techniques, ophthalmic practice and medical care environments, and glaucoma managements in different countries.…”

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

“…The mean reduction in IOP from 32.2 mm Hg (median ¼ 30.5; SD ¼ 11.4) in the preoperative period to 17.8 mm Hg (median ¼ 17.0; SD ¼ 5.8) at a year follow-up compares with report from other previous studies. 4,[17][18][19] There was no significant difference between the 5-FU and the non-5-FU groups at a year follow-up in term of their mean IOP (P ¼ 0.6). The survival curve between the two groups also failed to demonstrate any added advantage to the use of antimetabolites.…”