Purpose:
To evaluate the long-term outcomes of ‘modern’ trabeculectomy in a large series of glaucoma patients and determine whether ‘traditional’ factors for failure of trabeculectomy still applied.
Methods:
Single centre, observational cohort study of 555 consecutive ‘modern’, augmented ‘safe-technique’ trabeculectomies performed over a 10-year period (1998-2008). Traditional risk factors for failure (previous surgery, long-term exposure to topical medication, young age, secondary glaucoma and trainee surgeon) were assessed with respect to various success outcome criteria. A significant number of patients had more than one risk factor, so a multivariate logistic regression analysis was performed. Success survival was defined with respect to various intraocular pressure (IOP) targets, without (complete) or with anti-glaucoma medication use (qualified).
Results:
The mean follow-up period for the entire cohort was 66.0(±35.2) months. At final follow-up the mean IOP for all eyes was reduced from 23.5(±6.3)mmHg pre-operatively to 12.0(±4.1)mmHg (p<0.001) and the mean number of topical anti-glaucoma medications was reduced from 2.4 to 0.4 (p<0.001). Complete success (IOP<15mmHg, no medications) was 68% at final follow-up. Outcomes for the various risk factor groups were compared with a ‘risk-free’ control group (see Table for final IOP outcome analysis). Final IOP for the ‘risk-free’ eyes was 12.2(±4.2)mmHg, with a mean number of 0.4 medications. Traditional risk factors for failure did not influence outcome for the various success criteria, but surgery performed by trainee surgeons had significantly worse outcomes compared to surgery performed by a more senior surgeon.
Conclusions:
In a large cohort of mainly Caucasian patients, appropriately augmented, ‘modern’, ‘safe-technique’ trabeculectomy was highly successful and appeared to annul the effect of the ‘traditional’ risk factors for failure such as previous surgery, long-term exposure to topical medication, young age and secondary glaucoma. However, trabeculectomies performed by trainee surgeons tended to be less effective than those performed by a senior surgeon.
Keywords: intraocular pressure • clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: risk factor assessment