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K. Iwao, M. Inatani, K. Seto, Y. Takihara, M. Ogata-Iwao, S. Okinami, H. Tanihara; The Long-Term Outcome and Prognostic Factors for Trabeculectomy in Uveitis-Related Glaucoma Eyes: Retrospective Cohort Study at 2 Clinical Centers. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4419.
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To elucidate the long-term outcome and prognostic factors for trabeculectomy with mitomycin C in eyes with uveitis-related glaucoma (UG).
Setting: The retrospective consecutive comparative cohort study was conducted at 2 clinical centers in Japan. Patient population: Two hundred patients including 100 eyes with UG and 100 eyes with primary open-angle glaucoma (POAG) who underwent trabeculectomy with mitomycin C between 1999 and 2008. Observation procedures: IOP levels and cataract progression after surgery.
The mean follow-up periods were 35.0 ± 38.1 and 38.5 ± 34.8 months in UG and POAG, respectively. Diagnosis of UG included sarcoidosis (11 patients), Behçet’s disease (10 patients), Vogt-Koyanagi-Harada disease (5 patients), HTLV-1-associated uveitis (2 patients) and other types of UG (18 patients). Fifty-four eyes were diagnosed with idiopathic UG. Five-year probabilities of success after trabeculectomy were 61.6% and 82.3% in UG and POAG, respectively (p = 0.018). Multivariate model showed that UG eyes with previous cataract surgery (relative risk [RR] = 3.047, p = 0.0282) and granulomatous uveitis (RR = 4.083, p = 0.0075) were associated with surgical failure. UG eyes encountered more frequent cataract surgeries after trabeculectomy than POAG eyes (5-year probabilities of success: 37.4% and 89.3% in UG and POAG, respectively; p < 0.0001). There was no significant difference in the frequency of other complications, such as bleb leakage, hypotensive maculopathy, severe anterior chamber hemorrhage and infectious endophthalmitis.
Main Outcome Measures: :
IOP levels (≥ 21 mm Hg) or additional glaucoma surgeries were defined as surgical failure. Kaplan-Meier curves for surgical failure were compared between UG and POAG eyes. Prognostic factors for surgical failure of trabeculectomy in UG eyes were analyzed by Cox proportional hazards model. Moreover, the comparison of the frequency of an additional cataract surgery after trabeculectomy between UG and POAG eyes was evaluated using the log-rank test.
Trabeculectomy with mitomycin C in UG eyes is less effective to maintain IOP reduction than that in POAG eyes. The prognostic factors for surgical failure of trabeculectomy in UG eyes were previous cataract surgery and granulomatous uveitis. Additionally, UG eyes after trabeculectomy frequently require the surgical treatment of secondary cataract.
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