Long-Term Outcomes of Primary Trabeculectomy in Diabetic Patients without Retinopathy with Primary Angle-Closure Glaucoma

Abstract

Purpose. To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients without retinopathy with primary angle-closure glaucoma (PACG). Design. This is a retrospective case series comparison. Participants. This retrospective trial compared outcomes of 88 eyes that underwent trabeculectomy in patients with diabetes mellitus (DM) without retinopathy and in 97 patients without DM. Methods. In this study, the intraocular pressure (IOP), visual acuity, visual field, and postoperative complications were compared between the two groups. Qualified surgical success is defined as an IOP between 6 and 18 mmHg with or without topical antiglaucoma medication. Results. After a follow-up of 5 years, the IOP decreased from a mean basal IOP of 27.8 ± 7.3 mmHg to 15.0 ± 5.6 mmHg in the DM group and from 27.3 ± 6.0 mmHg to 12.4 ± 5.3 mmHg in the control group. The mean number of antiglaucoma medications was 3.4 ± 1.3 and 3.3 ± 1.2 preoperatively (P = 0.587) whereas it was 1.7 ± 1.5 and 1.1 ± 1.4 at the 5-year follow-up (P = 0.049). The 5-year qualified surgical success rates were 42.9% and 65.4% for both groups (P = 0.046; log-rank test). Encysted blebs were seen in 21 (23.9%) patients in the DM group and in 12 (12.4%) patients in the control group (P = 0.041). Conclusion. PACG patients with DM without retinopathy undergoing primary trabeculectomy with MMC may have a lower long-term surgical survival rate compared with patients without DM.

Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma

“…24.8 mmHg in PACG undergoing trabeculectomy. [ 11 12 13 21 ] There are few reports on medical management of PACG reported so far. [ 22 23 24 25 26 27 ]…”

“…achieved an IOP of <18 mmHg in 65.40% PACG posttrabeculectomy. [ 12 ] Chen et al . recorded a mean IOP of 14.9 ± 3.8 mmHg 1 year after trabeculectomy.…”

“…A 55–62% fall in IOP has been reported in PACG after trabeculectomy. [ 11 12 ] Tham et al . reported 8.9 mmHg or 36% fall in IOP 2 years after trabeculectomy in PACG.…”

“…Medical therapy alone may be unable to achieve mandated IOP in all, while trabeculectomy is feared to have an increased risk of postoperative shallow anterior chamber (AC), malignant glaucoma, or cataract formation. [ 10 11 12 13 14 15 ] Therefore, an early decision about appropriate Target IOP and initial medical versus surgical treatment is of crucial importance at different severities of PACG, which would prevent progression.…”

Trabekulektomie mit Mitomycin C und Ologen®-Implantat im Vergleich zur klassischen Trabekulektomie

“…Präoperativ gelten konjunktivale Voroperationen, lange topische Glaukomtherapie, Konjunktivitis und junges Alter als Risikofaktoren für das Versagen der TE durch Vernarbungen [23]. Zudem können Systemerkrankungen wie Diabetes mellitus den postoperativen Wundheilungsprozess erheblich beeinflussen [11,17]. In unserem Patientenkollektiv bestand kein signifikanter Unterschied zwischen beiden Gruppen hinsichtlich der Häufigkeiten von Systemerkrankungen, somit übten diese Faktoren keinen Einfluss auf die Studienergebnisse aus (p > 0,05).…”