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R. A. Puertas, K. Kaltsos, K. S. Lim, S. L. Lightman, C. E. Pavesio, C. Bunce, K. Barton; Uveitic Glaucoma: Long-Term Outcomes of Mitomycin-C Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):166.
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To assess the long-term success of Mitomycin Ctrabeculectomy in uveitic glaucoma and to identify predictors of failure.
153 eyes were followed 52 months (median)(range 12 - 115). The preoperative IOP of 29.9 ± 7.6 mmHg (mean ± SD) on 3.3 ± 0.8 medications dropped to 13.9 ± 6.7mmHg on 0.7 ± 1.1 medications at last follow-up. The median preop VA of 6/9 (range 6/5 - HM) was unchanged at last follow-up (6/9, range 6/5 to LP). 118 (77.1%) were using topical steroids, 30 (19.6%) systemic steroids and 13 (8.5%) systemic immunosuppression before surgery. Failure: There were 86 (54.9%) complete successes, 39 qualified failures (25.4%), 15 (9.8%) failures and 15 (9.8%) complete failures. We found little evidence of association between age, gender, race, type of uveitis and the failure categories. Preoperative IOP (p = 0.042) was associated with higher risk. There was a slight excess risk (of borderline significance, p = 0.068) in the 44 pseudophakic eyes (28.8%). However, in comparison with the 42 (27.5%) eyes that remained phakic throughout, pseudophakes (p=0.009) and those having later cataract surgery (67, 43.8%)(p = 0.039) were more likely to fail.
72.5% of trabeculectomy eyes required cataract surgery, with a detrimental influence on IOP control. The optimal timing for cataract surgery warrants further investigation.
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