Risk Factors for Early Filtration Failure Requiring Suture Release After Primary Glaucoma Triple Procedure With Adjunctive Mitomycin

Abstract

Postoperative release of scleral flap closure suture is useful in trabeculectomy combined with cataract surgery. We determined risk factors for early filtration failure requiring suture release during the first month after primary glaucoma triple procedure. Methods: The medical records of 71 consecutive patients with primary open-angle glaucoma who underwent a primary glaucoma triple procedure (primary trabeculectomy, phacoemulsification, and posterior chamber intraocular lens implantation) were reviewed. Suture release had been performed in 24 of the patients for early filtration failure with postoperative intraocular pressure greater than the target value during the first postoperative month. The long-term filtration failure was defined according to 2 criteria based on medical dependency and requirement of additional surgical procedure for intraocular pressure control. Cox proportional hazards multivariate analysis was performed to identify independent risk factors. Results: African American race (P = .02), more than 2 preoperative glaucoma drugs (P = .02), and intraocular pressure greater than 14 mm Hg during the first postoperative week (P = .006) were identified as significant independent risk factors requiring suture release for filtration failure during the first postoperative month. Their significance was further confirmed by Kaplan-Meier survival analysis with Mantel-Cox log-rank test (P = .03, P = .02, and P = .001, respectively). Conclusions: African American race, more than 2 preoperative medications, and intraocular pressure greater than 14 mm Hg in the first postoperative week are major independent risk factors for initial filtration failure requiring suture release during the first month after primary glaucoma triple procedure. Presence of the risk factors may warrant a more aggressive antiproliferative regimen and/or earlier suture release.

Adenovirus-mediated delivery of p27KIP1 to prevent wound healing after experimental glaucoma filtration surgery

“…The common clinical practice is to administer either 5-FU postoperatively by subconjunctival injection or MMC intraoperatively by local application. However, treatment with 5-FU and MMC is often associated with serious adverse effects, such as corneal epithelial defects, wound leaks, and hypotony with accompanying vision loss [1][2][3][4] . These problems have stimulated the search for alternative modes of drug delivery and new agents to minimize ocular complications.…”

“…The local use of antiproliferative agents, such as mitomycin C (MMC) and 5-fluorouracil (5-FU), has improved the surgery outcome by preventing cell growth and scar formation. However, the administration of these drugs can result in a variety of toxicities, including wound leakage, corneal erosion and, rarely, necrosis of the corneal stroma and iris, chronic hypotony, corneal stromal neovascularization, and scleral ulceration [1][2][3][4] .…”

Risk Factors and Open-angle Glaucoma: Classification and Application

“…46 The IOPlowering by eyedrops has been reported to be less in eyes that are more heavily pigmented, although this may not be as true for prostaglandins as it was for pilocarpine, epinephrine, and b-blockers. There is some evidence that trabeculectomy is somewhat less effective in Africanderived than European-derived persons, 110 but the difference may not survive adjustment for disease severity. 111 Furthermore, the effect was not seen in other clinical trials, such as the Fluorouracil Filtering Surgery Trial.…”

A review of trabeculectomy in East Asian people—the influence of race

“…It was established early on in its history that trabeculectomy in black subjects failed earlier compared to white subjects, presumably due to a more vigorous fibrotic response in the subconjunctival space. [16][17][18][19][20][21][22] The reason black populations were studied in preference to the East Asian populations, for example, was probably because comparatively large communities of African-American blacks in the USA and Afro-Caribbean blacks in the UK provided a ready population to study in the countries where most of the academic literature was arising from.…”