Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population.
OBJECTIVE
A retrospective cohort study was undertaken to evaluate and compare the long-term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population.


METHODS
Yearly diurnal measurements of intraocular pressure (IOP), best-corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti-mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed.


RESULTS
Sixty-four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to < or = 21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two-line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline.


CONCLUSIONS
Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.
Sihota
Ramanjit
R
Dr Rajendra Prasad Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. rjsihota@hotmail.com
Gupta
Viney
V
Agarwal
Harish C
HC
D000368:Aged; D002386:Cataract / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000208:ethnology / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000208:ethnology / Q000601:surgery*; D006801:Humans; D007194:India / Q000453:epidemiology; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity