Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure.
OBJECTIVE
To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure.


METHODS
Retrospective cohort study.


METHODS
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) < or = 18 mm Hg and IOP reduction > or = 20%; (B) IOP < or = 15 mm Hg and IOP reduction > or = 25%; and (C) IOP < or = 12 mm Hg and IOP reduction > or = 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.


RESULTS
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.


CONCLUSIONS
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.
Glaucoma Division, Jules Stein Eye Institute, University of California, Los Angeles, California, USA.
Hector
H
Fontana
Kouros
K
Nouri-Mahdavi
Joseph
J
Caprioli
D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications; D019591:Pseudophakia / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin