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Sooncheol Cha, Won mo Gu, Su-Ho Lim, Min Sagong; Long-term Comparative Results of Trabeculectomy in Patients with Exfoliative Glaucoma versus Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3163.
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In published studies on Caucasian subjects, the surgical outcome of trabeculectomy for XFG was reported not much different from that for POAG or even better in spite of more severe destruction of the blood aqueous barrier after trabeculectomy. The purpose of this study was to compare long-term surgical outcomes in exfoliative glaucoma (XFG) versus primary open angle glaucoma (POAG) after primary trabeculectomy with adjunctive mitomycin C (MMC) in Asian patients and to analyze risk factors for surgical failure.
The study group included 32 eyes of XFG and 64 eyes of POAG matched by propensity score analysis in this case control study. Success rates were defined according to three different criteria: (A) intraocular pressure (IOP)<18 mmHg and IOP reduction ≥20% without medication; (B) IOP<15mmHg and IOP reduction≥25% without medication; (C) IOP <18 mmHg with or without medications. Cumulative success rates were compared using Kaplan-Meier survival curve, and risk factors for surgical failure were identified by Cox proportional hazard regression analysis.
Complete success rates were 84.4% at 1 year, and 19.9% at 5 years in XFG, while 82.3% at 1 year, 64.7% at 5 years in POAG by Criteria A. Complete success rates were significantly lower in XFG than in POAG by Criteria A and B respectively. However, the qualified success did not show a statistically significant difference by Criteria C. Postoperative hyphema was more frequent in XFG. The risk factors associated with surgical failure were young age group (Hazard Ratio=2.58, P=0.047, Criteria A) and exfoliation syndrome (HR=3.01,2.96, P =0.006, 0.005, Criteria A and B).
Although trabeculectomy for XFG had similar IOP control comparable to that for POAG at 1 year, XFG showed a worse long-term IOP control than POAG after 2 years postoperatively. Thus, ophthalmologist should consider that trabeculectomy might be difficult to achieve a long-term low target IOP control when planning the surgery for XFG.
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