title: Trabeculectomy with mitomycin for open-angle glaucoma in phakic vs pseudophakic eyes after phacoemulsification.
abstract: OBJECTIVE
  To determine whether previous phacoemulsification adversely affects surgical prognosis of trabeculectomy with mitomycin for open-angle glaucoma.
  
  
  METHODS
  The study is a retrospective, consecutive, comparative case series. At 2 clinical centers, we reviewed 226 medical records of eyes with open-angle glaucoma undergoing initial trabeculectomy, including 175 phakic eyes (phakic group) and 51 pseudophakic eyes that had previously undergone phacoemulsification with superior conjunctival incision (pseudophakic group). Primary outcome was the probability of success after trabeculectomy. Surgical failure was defined as an additional glaucoma surgery or 1 of the following 3 criteria: intraocular pressure (IOP) of 21 mm Hg or greater (A); IOP of 18 mm Hg or greater (B); and IOP of 15 mm Hg or greater (C). Multivariable analysis was performed using the Cox proportional hazards model.
  
  
  RESULTS
  The mean follow-up period was 37.5 months. The probability of success for criteria A, B, and C at 1 and 3 years in the phakic vs the pseudophakic group was 97.8% and 92.6%, respectively, vs 78.6% and 65.1%, respectively, for criterion A (P < .001); 92.9% and 81.3%, respectively, vs 72.8% and 63.7%, respectively, for criterion B (P = .004); and 73.1% and 54.2%, respectively, vs 53.1% and 38.4%, respectively, for criterion C (P = .009). The multivariable model confirmed that pseudophakia independently contributes to surgical failure (criterion A relative risk, 4.59 [P < .001]; criterion B, 2.88 [P = .004]; and criterion C, 2.02 [P = .009]). The pseudophakic group required more postoperative laser suture lysis (P = .01).
  
  
  CONCLUSIONS
  Previous phacoemulsification is a prognostic factor for surgical failure of trabeculectomy with mitomycin for open-angle glaucoma.
authors.affiliation: Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto City, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takihara
authors.forename: Masaru
authors.initials: M
authors.lastname: Inatani
authors.forename: Takahiko
authors.initials: T
authors.lastname: Seto
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Iwao
authors.forename: Minako
authors.initials: M
authors.lastname: Iwao
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Nanako
authors.initials: N
authors.lastname: Kasaoka
authors.forename: Akira
authors.initials: A
authors.lastname: Murakami
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Futa
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Tanihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure; D007908:Lens, Crystalline / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D018918:Phacoemulsification; D011379:Prognosis; D016016:Proportional Hazards Models; D019591:Pseudophakia / Q000503:physiopathology*; D012189:Retrospective Studies; D014130:Trabeculectomy
chemical_list: D000477:Alkylating Agents; D000959:Antihypertensive Agents; D016685:Mitomycin