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Ophthalmology. 2012 Apr;119(4):694-702. doi: 10.1016/j.ophtha.2011.09.043. Epub 2011 Dec 23.

A twenty-year follow-up study of trabeculectomy: risk factors and outcomes.

Author information

1
Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, United Kingdom. john.landers@bigpond.com

Abstract

PURPOSE:

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.

DESIGN:

Retrospective cohort study.

PARTICIPANTS:

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.

MAIN OUTCOME MEASURES:

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.

Comment in

PMID:
22196977
DOI:
10.1016/j.ophtha.2011.09.043
[Indexed for MEDLINE]

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