Abstract
Abstract: :
Purpose: Repeat trabeculectomy is known to have lower success rates than primary trabeculectomy in pirmary open angle glaucoma (POAG) patients. This study aimed at investigating whether repeat trabeculectomy have worse surgical outcomes than primary trabeculectomy in POAG patients when intraoperative adjunctive mitomycin C (MMC) was used. Methods: Medical records of 64 consecutive POAG patients (72 eyes) who had undergone standard trabeculectomy with MMC and miminum follow–up of 6 months were retrospectively reviewed. The patients were divided into two groups; Group I (repeat trabeculectomy,18 eyes of 18 patients), Group II (primary trabeculectomy, 54 eyes of 46 patients). Demographic, preoperative and postoperative data were collected for up to 72 months. We compared success rates and complications between two groups and analyzed risk factors for surgical failure. Kaplan–Meier survival analysis was used for probability of cumulative success estimations according to success criteria (defined as IOP of 21 mmHg or less without glaucoma medications; complete success, and IOP of 21 mmHg or less with glaucoma medications; qualified success). Results: No statistically significant differences were found in gender, age, follow–up, and preoperative medications between two groups. Preoperative mean IOP in group I (29.3±6.5 mmHg) were higher than group II (24.7±3.9 mmHg)(p<0.05). There were no statistically significant differences of final postoperative IOP between group I (14.9±5.4 mmHg) and group II (14.4±5.8 mmHg). Complete success rates in group I (50%) were lower than those in group II (85.2%) after mean follow–up period of 28.1 months(p<0.05). However, qualified success rates were not significantly different between group I (88.9%) and group II (90.7%). Cumulative qualified success rates of group I were 94.4% at 12 months, 87.2% at 24 months, and 87.2% at 36 months. Those of group II were 100%, 93.9% and 81.7% , respectively. There were no statistically significant differences between two groups (log–rank test, p>0.05). Conclusions: Despite of the lower complete success rates of repeat trabeculectomy patients, qualifed success rates of repeat trabeculectomy with MMC were similar to those of primary trabeculectomy with MMC in POAG patients. Therefore, this study suggest that repeat trabeculectomy with MMC could be effective as the primary surgical procedure before considering glaucoma drainage device implatation in previous failed trabeculectomy patients.
Keywords: wound healing • clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials