title: Same-site Trabeculectomy Revision for Failed Trabeculectomy: Outcomes and Risk Factors for Failure.
abstract: OBJECTIVE
  To evaluate long-term tonometric outcomes of same-site trabeculectomy revision with mitomycin C (MMC) after failure of an initial trabeculectomy, and to identify risk factors for failure in patients with open-angle glaucoma.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One-hundred and seventeen patients (130 eyes) with primary open-angle, pseudoexfoliation, or pigmentary glaucoma, who failed a first trabeculectomy and who were ≥40 years of age at the time of same-site trabeculectomy revision, were included. Three levels of success criteria were defined: (A) intraocular pressure (IOP) ≤18 mm Hg and IOP reduction of 20%; (B) IOP ≤15 mm Hg and IOP reduction of 25%; and (C) IOP ≤12 mm Hg and IOP reduction of 30%. The primary outcome was the qualified Kaplan-Meier success rate (with or without medications) for each criterion. Cox multivariate regression analysis was used to identify risk factors for failure.
  
  
  RESULTS
  The success rates (± standard error) at the first, third, and fifth years of follow-up for criterion A were 69.7% (± 4.1%), 58.2% (± 4.6%), and 51.1% (± 5.0%); for criterion B these were 60.9% (± 4.4%), 47.8% (± 4.7%), and 44.0 (± 4.8%); and for criterion C, 44.6% (± 4.5%), 29.7% (± 4.4%), and 25.8% (± 4.3%). Mean follow-up was 5.2 (± 3.6) years. A time interval between the first and the same-site trabeculectomy revision of <3 years, worse baseline visual acuity, and dyslipidemia were significant risk factors for failure.
  
  
  CONCLUSIONS
  Given the long-term tonometric success rates along with significant medication reduction, same-site trabeculectomy revision with MMC should be considered as a viable option to achieve reasonable IOP targets after a first failed trabeculectomy in open-angle glaucoma patients.
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Pradtana
authors: P
authors: Hirunpatravong
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Alizadeh
authors: A
authors: Reza
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Pablo
authors: P
authors: Romero
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Eun Ah
authors: EA
authors: Kim
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Kouros
authors: K
authors: Nouri-Mahdavi
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Simon K
authors: SK
authors: Law
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Esteban
authors: E
authors: Morales
authors: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: Caprioli@jsei.ucla.edu.
authors: Joseph
authors: J
authors: Caprioli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin