Trabeculectomy with mitomycin C for neovascular glaucoma: prognostic factors for surgical failure.
OBJECTIVE
To evaluate the prognostic factors for surgical outcomes of trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG).


METHODS
Retrospective cohort study.


METHODS
We reviewed the medical records of 101 patients (101 eyes) with NVG treated at Kumamoto University Hospital. The primary endpoint was persistent intraocular pressure > or = 22 mm Hg, deterioration of visual acuity to no light perception, and additional glaucoma procedures. Multivariate analysis was performed using the Cox proportional hazards model.


RESULTS
The mean follow-up period was 29.3 months (range, 0.5 to 142.3 months). The probability of success 1, 2, and 5 years after trabeculectomy was 62.6%, 58.2%, and 51.7%, respectively. The multivariate model showed that younger age (relative risk [RR], 0.96/year; P = .0007) and previous vitrectomy (RR, 1.62; P = .02) were prognostic factors for surgical failure among all NVG patients. Additionally, an eye with unremoved proliferative membrane and/or unrepaired retinal detachment (RD) after vitrectomy (RR, 1.59; P = .05) was a probable prognostic factor in a subgroup of 66 eyes with previous vitrectomy, and having a fellow eye with NVG (RR, 1.73; P = .003) was a significant prognostic factor in 82 eyes with NVG attributable to diabetic retinopathy.


CONCLUSIONS
The prognostic factors for surgical failure of trabeculectomy with MMC for NVG were younger age and previous vitrectomy in all NVG patients, and having a fellow eye with NVG in patients with disease caused by diabetic retinopathy. Persistent proliferative membrane and/or RD after vitrectomy might contribute to poorer outcomes of trabeculectomy.
Takihara
Yuji
Y
Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, Kumamoto City, Japan.
Inatani
Masaru
M
Fukushima
Mikiko
M
Iwao
Keiichiro
K
Iwao
Minako
M
Tanihara
Hidenobu
H
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011379:Prognosis; D016016:Proportional Hazards Models; D012163:Retinal Detachment / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000379:methods*; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000009:adverse effects; D055815:Young Adult
D000477:Alkylating Agents; D016685:Mitomycin