Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study.
OBJECTIVE
To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes.


METHODS
This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as "failures".


RESULTS
There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed.


CONCLUSIONS
If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma.
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Kentaro
K
Iwasaki
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Yoshihiro
Y
Takamura
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Takashi
T
Nishida
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Akira
A
Sawada
Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Keiichiro
K
Iwao
Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Ayano
A
Shinmura
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Shiho
S
Kunimatsu-Sanuki
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Tetsuya
T
Yamamoto
Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Hidenobu
H
Tanihara
Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Kazuhisa
K
Sugiyama
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Toru
T
Nakazawa
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Masaru
http://orcid.org/0000-0003-0896-996X
M
Inatani
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome