Trabeculectomy With Mitomycin C in Pseudophakic Patients With Open-angle Glaucoma: Outcomes and Risk Factors For Failure

• Published in: American journal of ophthalmology Vol. 141; no. 4; pp. 652 - 659
• Main Authors: Fontana, Hector, Nouri-Mahdavi, Kouros, Caprioli, Joseph
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2006; Elsevier; Elsevier Limited
• Subjects: Age; Aged; Aged, 80 and over; Antibiotics, Antineoplastic - administration & dosage; Biological and medical sciences; Cataracts; Colleges & universities; Combined Modality Therapy; Female; Gender; Glaucoma; Glaucoma and intraocular pressure; Glaucoma, Open-Angle - drug therapy; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure; Intraoperative Complications; Lasers; Male; Medical sciences; Middle Aged; Miscellaneous; Mitomycin - administration & dosage; Ophthalmology; Patients; Postoperative Complications; Pseudophakia - complications; Retrospective Studies; Risk Factors; Success; Surgery; Trabeculectomy - methods; Treatment Failure; Treatment Outcome; Wound healing; Antineoplastic agent; Human; Trabeculectomy; Mitomycin; Prognosis; Open angle glaucoma; Eye disease; Antibiotic; Treatment; Surgery; Risk factor; Evolution; Ophthalmology; Intraocular lens; Failure
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2005.11.039

To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. Retrospective cohort study. Seventy-three pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥20%; (B) IOP ≤15 mm Hg and IOP reduction ≥25%; and (C) IOP ≤12 mm Hg and IOP reduction ≥30%. IOP, visual acuity, complications, and additional interventions were documented after surgery. Cox’s proportional hazard regression analysis was used to identify risk factors for failure. Mean IOP (±SD) decreased from a preoperative value of 18.8 ± 6.6 mm Hg to 10.2 ± 5.1 mm Hg at one year and to 10.0 ± 4.2 at two years ( P < .001 for both). Average number of preoperative medications decreased from 3.0 ± 1.1 to 0.5 ± 1.0 at one year and to 0.5 ± 0.9 at two years ( P < .001 for both). For criteria A, B, and C, success rates (±SE) were 87% ± 4%, 83% ± 5%, and 76% ± 5% at 1 year and 67% ± 4%, 58% ± 8%, and 50% ± 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.