Abstract
Purpose :
Despite the recent introduction of innovative and minimally invasive surgical methods, trabeculectomy remains the most widely performed surgical procedure for lowering intraocular pressure (IOP). However, limited studies have reported its outcomes over 10 years. We evaluated the extended long-term outcomes of trabeculectomy with mitomycin C (MMC) and the factors associated with its successful outcomes.
Methods :
We retrospectively evaluated 509 eyes that underwent trabeculectomy with MMC performed by a single surgeon from 1999 and were followed up for more than 10 years. We investigated cumulative surgical success and blindness rates and postoperative complications. Surgical success was defined as no requirement for reoperation, IOP≤15mmHg, and no loss of light perception. Legal blindness was defined as visual acuity<3/60. To determine the cumulative dose of IOP-lowering eyedrops, the glaucoma medication index (GMI) was calculated by multiplying the number of eyedrops by the number of years of use. We also investigated the factors associated with surgical failure using Cox regression analysis.
Results :
The average follow-up period after the trabeculectomy was 14.6 years (range: 10.0-23.1years). The Kaplan–Meier survival analysis showed that the cumulative qualified success rates were 90.0%, 81.7%, 76.4%, and 74.7% at 5, 10, 15, and 20 years after the trabeculectomy, respectively. Overall, 14.3% of the total eyes became legally blind. The most common complication following surgery was cataract (23.5%), followed by hyphema (9.1%) and bleb leaks (7.1%). Patients with older age, certain glaucoma subtypes (i.e., neovascular glaucoma and exfoliative glaucoma), a worse visual field mean deviation, and a greater GMI were significantly associated with lower complete success rates of trabeculectomy. The IOP at 1 year after surgery was a strong indicator of long-term surgical success. Unexpectedly, the number of preoperative eyedrops per se, the preoperative IOP, and subsequent cataract surgery did not affect long-term surgical success.
Conclusions :
This study showed that trabeculectomy with MMC is an effective and safe surgical procedure for uncontrolled glaucoma in the long term. Patients with certain risk factors, such as exfoliative glaucoma and prior use of multiple IOP-lowering eyedrops over prolonged periods, require more attention for long-term postoperative IOP management.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.