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Ophthalmology. 2006 Jun;113(6):930-6. Epub 2006 Apr 27.

Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic open-angle glaucoma.

Author information

1
Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA.

Abstract

PURPOSE:

To evaluate long-term tonometric outcomes of trabeculectomy with adjunctive mitomycin C (MMC) and its efficacy in achieving a range of intraocular pressures (IOP) in phakic patients with open-angle glaucoma.

DESIGN:

Retrospective cohort study.

METHODS:

Three levels of success were defined by these criteria: (A) IOP < or =18 mmHg and IOP reduction of 20%; (B) IOP < or =15 mmHg and IOP reduction of 25%; and (C) IOP < or =12 and IOP reduction of 30%. Kaplan-Meier survival analyses were used to assess outcomes. Cox's proportional hazard regression analysis was used to identify risk factors for failure.

PARTICIPANTS:

Two hundred twenty-five phakic patients (292 eyes) with open-angle glaucoma, > or =40 years of age at time of trabeculectomy.

MAIN OUTCOME MEASURES:

The primary outcome was qualified success rate (with or without medications) according to the defined criteria. Secondary outcomes include IOP level and number of medications at 1 and 3 years after surgery, postoperative complications, and need for further glaucoma surgery.

RESULTS:

Mean IOP (+/-standard deviation) decreased from 18.8 mmHg (+/-6.1 mmHg) before surgery to 11.3 mmHg (+/-4.5 mmHg) at 1 year and 11.1 mmHg (+/-4.2 mmHg) at 3 years (P<0.001 for both). The mean number of medications decreased from 2.8 (+/-1.0) to 0.4 (+/-0.7) at 1 year and 0.7 (+/-1.0) at 3 years (P<0.001 for both). The success rates were 85%, 84%, and 79% at 1 year for criteria A, B, and C, respectively; and 62%, 56%, and 46% for these criteria, respectively, at 3 years. Postoperative laser suture lysis was associated with a higher rate of failure for criteria B and C (P<0.001 for both), the hazard ratio (HR) was 1.7 for criteria B and 2.0 for criteria C. Prior argon laser trabeculoplasty was associated with higher risk of failure for criteria C (HR = 1.6; P = 0.05).

CONCLUSIONS:

Trabeculectomy with MMC effectively reduces IOP in phakic open-angle glaucoma, but long-term low IOPs are achieved in only half of the cases. Laser suture lysis after trabeculectomy and prior argon laser trabeculoplasty are associated with a higher risk of failure when low IOPs are required.

Comment in

PMID:
16647135
DOI:
10.1016/j.ophtha.2006.01.062
[Indexed for MEDLINE]

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