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Kentaro Iwasaki, Yoshihiro Takamura, Takashi Nishida, Akira Sawada, Keiichiro Iwao, Ayano Shinmura, Shiho Kunimatsu-Sanuki, Hidenobu Tanihara, Kazuhisa Sugiyama, Toru Nakazawa, Masaru Inatani; Trabeculectomy in Both Eyes; the First-Operated Versus the Second-Operated Eyes: A Comparative, Multicenter Study.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2949.
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© ARVO (1962-2015); The Authors (2016-present)
<div>Despite of the successful intraocular pressure (IOP) reduction after trabeculectomy in one eye, trabeculectomy in the other eye often results in surgical failure. We evaluated, when both eyes are treated, whether the surgical outcome of trabeculectomy in the second eye is worse than that in the first eye.</div>
<div>The retrospective, comparative studies were conducted for patients who had undergone trabeculectomy in both eyes at 5 clinical centers in Japan. Inclusion criteria are open-angle glaucoma; both eyes operated by one surgeon. Exclusion criteria are patients with one phakic and the other pseudophakic eyes before trabeculectomy; patients with prior vitrectomy or prior filtering surgery; patients with one fornix-based and the other limbus-based trabeculectomized eyes. Surgical failure was defined as <20% reduction of the preoperative IOP, reoperation, or loss of light perception vision, hypotony of <5 mmHg, or IOP >21 mmHg (criterion A), IOP >18 mmHg (criterion B), or IOP >15 mmHg (criterion C).</div>
<div>Eighty-eight patients satisfied the criteria. The probability of success at 3 years in the first-operated eyes vs in the second-operated eyes was 72.2% vs 60.6% for criterion A (P=0.12), 57.8% vs 54.2% for criterion B (P=0.57) and 42.6% vs 41.6% for criterion C (P=0.68), respectively. In the subgroup analysis of the patients that had success in the first-operated eyes, the interval between trabeculectomies was significantly longer when the second eyes failed than when they were successful, exhibiting the mean interval of 574 vs 175 days for criterion A (P=0.0023), 518 vs 150 days for criterion B (P=0.0026) and 508 vs 142 days for criterion C (P=0.011), respectively. The probability of success showed significantly worse outcomes in the group of the interval >2 months than <2 months (77.5% vs 91.9% for criterion A, P=0.013). The subgroup analysis of the failed first-operated eyes showed no significant differences of surgical intervals between the successful and failed second-operated eyes.</div>
If the first-operated eyes are successful, the long interval between the trabeculectomies results in surgical failure of the second eyes. Because the long-term successful filtration exposes intraocular antigens to the lymphocytes in the conjunctiva, systemic immune reaction might occur, causing failure in the second-operated eyes..
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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