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K. Iwao, M. Inatani, Steroid-Induced Glaucoma Multicenter Study Group; Prognostic Factors and Long-Term Outcome of Trabeculotomy for Steroid-Induced Glaucoma: Multicenter Retrospective Case-Control Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):454.
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To elucidate the prognostic factors and long-term outcome of trabeculotomy for steroid-induced glaucoma (SIG).
Setting: The retrospective interventional case-control study was conducted at 16 clinical centers in Japan. Patient population: Two hundred fifty-three patients including 155 eyes with SIG who underwent trabeculotomy (122 eyes) or trabeculectomy with mitomycin C (33 eyes), and 98 eyes with primary open-angle glaucoma (POAG) who underwent trabeculotomy, between 1997 and 2006. Observation procedures: IOP levels after surgery.
The mean follow-up period was 42.0 ± 32.1 months. Five-year probabilities of success after trabeculotomy for SIG were 76.3% in criteria A and 53.4% in criteria B. Multivariate model showed that SIG caused by ocular instillation of corticosteroid eye drops was a favorable prognostic factor (relative risk [RR] = 0.37, p = 0.037) while previous vitrectomy was a poor prognostic factor (RR = 3.84, p = 0.038). Five-year probabilities of success after trabeculotomy for POAG were 51.9% in criteria A and 28.7% in criteria B, indicating significantly poorer success than those for SIG (p = 0.0002 in criteria A and p < 0.0001 in criteria B). Five-year probabilities of success after trabeculectomy for SIG were 72.7% in criteria A, and 67.3% in criteria B. No significant difference was found between trabeculotomy and trabeculectomy (p = 0.670 in criteria A and p = 0.110 in criteria B).
The prognostic factors for surgical outcomes of trabeculotomy for SIG were glaucoma caused by ocular instillation of corticosteroid eye drops as favorable factor and previous vitrectomy as poor prognostic factor. SIG eyes after trabeculotomy show more stable IOP reduction than POAG eyes after trabeculotomy. Trabeculotomy offers long-term IOP reduction (less than 21 mmHg) comparable with trabeculectomy with mitomycin C in the treatment for SIG.
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