title: A twenty-year follow-up study of trabeculectomy: risk factors and outcomes.
abstract: OBJECTIVE
  This study was undertaken to determine the performance of trabeculectomy surgery over a 20-year period and examine the associations between outcome and risk factors for trabeculectomy failure.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 234 patients (330 procedures) who had undergone trabeculectomy surgery at Addenbrooke's Hospital, Cambridge, United Kingdom, between January 1988 and December 1990.
  
  
  METHODS
  Patients were identified through surgical logbooks (n = 521 procedures on 380 patients); after this, a case-note review was undertaken, which identified 234 patients (330 procedures) who had available case notes.
  
  
  METHODS
  Surgical success was defined as "complete success" while intraocular pressure (IOP) remained <21 mm Hg with no additional medication and as "qualified success" if those requiring additional topical medication were included. Functional success was defined if patients did not progress to legal blindness (visual acuity <3/60 or visual field <10 degrees).
  
  
  RESULTS
  After 20 years, 57% were classified as complete success, 88% were classified as qualified success, and 15% had become blind. Those at risk of trabeculectomy failure were younger or had uveitic glaucoma. Those with pseudoexfoliation or aphakia were more likely to progress to blindness. Furthermore, those using 2 or more topical medications or with advanced visual field loss at the time of surgery were more at risk of both trabeculectomy failure and blindness.
  
  
  CONCLUSIONS
  This study indicates that trabeculectomy survival at 20 years may be approximately 60% with no topical medication and approximately 90% with additional topical medication. Patient age, preoperative topical medication use, glaucoma type, and glaucoma severity will independently influence this outcome. Trabeculectomy surgery is therefore a long-term solution to IOP control.
authors.affiliation: Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, United Kingdom. john.landers@bigpond.com
authors.forename: John
authors.initials: J
authors.lastname: Landers
authors.forename: Keith
authors.initials: K
authors.lastname: Martin
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sarkies
authors.forename: Rupert
authors.initials: R
authors.lastname: Bourne
authors.forename: Peter
authors.initials: P
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents