Long-term outcomes of primary trabeculectomy in diabetic patients with primary open angle glaucoma.
OBJECTIVE
To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients with primary open angle glaucoma (POAG).


METHODS
Patients with diabetes mellitus (DM) without retinopathy who had ≥6 months of postoperative follow-up were retrospectively compared with a control group selected from the pool of patients without DM matched case-by-case to the diabetic group by age, gender, race, preoperative intraocular pressure (IOP) and lens status. Surgical success was defined as IOP ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery.


RESULTS
41 eyes (29 patients) with DM and 81 eyes (64 patients) without DM were compared. Kaplan-Meier cumulative survival rates at 60 months were 57.8±9.3% (DM group) and 68.6±5.3% (control group), and the mean trabeculectomy survival times were 63 months (DM group, 95% CI 50.3 to 75.7) and 74.6 months (control group, 95% CI 67.1 to 82.1; p=0.095). Mean postoperative IOP of control group was statistically significant lower at 2-, 3-, 6- and 7-year follow-up visits (p<0.05). Rates of postoperative complications and additional glaucoma surgeries required were not different between the two groups.


CONCLUSIONS
POAG patients with DM without retinopathy undergoing primary trabeculectomy with MMC do not achieve the same long-term IOP control and may have a lower long-term surgical survival rate compared with patients without DM.
Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, 100 Stein Plaza #2-235, Los Angeles, CA 90095, USA. law@jsei.ucla.edu
Simon K
SK
Law
Hamid
H
Hosseini
Elham
E
Saidi
Nariman
N
Nassiri
Gundappa
G
Neelakanta
JoAnn A
JA
Giaconi
Joseph
J
Caprioli
D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology
D000477:Alkylating Agents; D000959:Antihypertensive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D016685:Mitomycin; C517652:hemoglobin A1c protein, human