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Long-term outcomes of repeat vs initial trabeculectomy in open-angle glaucoma
Simon K Law1, Karen Shih, Duc H Tran
1Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA. law@jsei.ucla.edu
American Journal of Ophthalmology
|July 15, 2009
Summary
Repeat trabeculectomy with mitomycin C (MMC) is less effective for open-angle glaucoma than initial surgery. Initial procedures showed higher success rates and required fewer medications long-term.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
Background:
- Open-angle glaucoma (OAG) management often requires surgical intervention.
- Trabeculectomy with mitomycin C (MMC) is a common surgical approach.
- Repeat trabeculectomy may be necessary when initial surgery fails.
Purpose of the Study:
- To compare the long-term efficacy of repeat trabeculectomy with MMC versus initial trabeculectomy with MMC in OAG.
- To identify risk factors associated with failure in repeat trabeculectomy procedures.
Main Methods:
- Retrospective case-control study comparing initial and repeat trabeculectomy with MMC.
- 75 eyes undergoing repeat surgery were matched with 75 eyes undergoing initial surgery.
- Surgical success defined by specific intraocular pressure (IOP) reduction criteria over time; risk factors analyzed using Cox regression.
Main Results:
- Initial trabeculectomy with MMC demonstrated significantly higher cumulative success rates at 3 years compared to repeat surgery (61.3% vs. 41.3% by criterion B; 52.0% vs. 32.0% by criterion C).
- Repeat trabeculectomy patients required more glaucoma medications (1.2 vs. 0.6).
- Younger age and laser suture lysis were identified as risk factors for failure in repeat trabeculectomy.
Conclusions:
- Repeat trabeculectomy with MMC is less successful in achieving long-term IOP control for open-angle glaucoma compared to initial trabeculectomy with MMC.
- Risk factors for failure in repeat surgery include younger age and the need for laser suture lysis.
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