Trabeculectomy With Mitomycin-C: Outcomes and Risk Factors for Failure in Primary Angle-closure Glaucoma. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Romero, Pablo; Hirunpatravong, Pradtana; Alizadeh, Reza; Kim, Eun-Ah; Nouri-Mahdavi, Kouros; Morales, Esteban; Law, Simon K.; Caprioli, Joseph
• Is Part Of: Journal of glaucoma. Volume 27:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: trabeculectomy -- primary angle closure -- IOP; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000000842
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Purpose: There are no reported large series of trabeculectomy with mitomycin-C (MMC) in Western patients with primary angle-closure glaucoma (PACG). Our study evaluates long-term tonometric outcomes of trabeculectomy in PACG. Materials and Methods: This is a retrospective cohort study. The primary outcomes were the Kaplan-Meier success rates on survival analyses using 3 criteria, with or without adjunctive medication: (A) intraocular pressure (IOP) ⩽18 mm Hg and IOP reduction of 20%; (B) IOP⩽15 mm Hg and IOP reduction 25%; and (C) IOP⩽12 mm Hg and IOP reduction 30%. In total, 136 eyes (102 patients) with PACG who underwent trabeculectomy MMC were included. The Cox proportional hazard regression analysis was used to identify risk factors for failure with multivariate analysis ( P <0.05). Results: The qualified success rates (±SD) after 1, 3, and 5 years of follow-up for criterion A were 92% (±2.2%), 78% (±3.8%), and 72% (±4.3%); for criterion B, 86% (±3.0%), 65% (±4.4%), and 59% (±4.7%); and for criterion C, 62% (±4.2%), 40% (±4.5%), and 32% (±4.4%). Baseline factors associated with failure were: family history, absence of laser peripheral iridotomy, higher IOP, and presence of a crystalline lens. Conclusions: Trabeculectomy with MMC effectively reduces IOP in PACG. Long-term IOP reduction is achieved for target IOP levels in the mid-teens. Presence of a crystalline lens, lack of iridotomy and higher preoperative IOP were associated with higher risks of failure.