Trabeculectomy With Mitomycin C in Pseudophakic Patients With Open-angle Glaucoma: Outcomes and Risk Factors For Failure

PurposeTo evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure.DesignRetrospective cohort study.MethodsSeventy-three pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥20%; (B) IOP ≤15 mm Hg and IOP reduction ≥25%; and (C) IOP ≤12 mm Hg and IOP reduction ≥30%. IOP, visual acuity, complications, and additional interventions were documented after surgery. Cox’s proportional hazard regression analysis was used to identify risk factors for failure.ResultsMean IOP (±SD) decreased from a preoperative value of 18.8 ± 6.6 mm Hg to 10.2 ± 5.1 mm Hg at one year and to 10.0 ± 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0 ± 1.1 to 0.5 ± 1.0 at one year and to 0.5 ± 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (±SE) were 87% ± 4%, 83% ± 5%, and 76% ± 5% at 1 year and 67% ± 4%, 58% ± 8%, and 50% ± 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure.ConclusionIncreasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.