Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Outcomes

Background:

• Advanced open-angle glaucoma (OAG) poses significant challenges for maintaining visual function.
• Trabeculectomy is a common surgical intervention for advanced OAG, but its long-term survival rates require careful evaluation.

Purpose of the Study:

• To assess the surgical survival rates of trabeculectomy in patients with advanced open-angle glaucoma (OAG).
• To identify clinical and demographic factors influencing the success of trabeculectomy in this patient population.

Main Methods:

• A retrospective longitudinal study involving 165 eyes of patients with advanced OAG undergoing primary trabeculectomy.
• Surgical survival was analyzed using Kaplan-Meier and Cox hazard ratio analyses based on various intraocular pressure (IOP) thresholds (≤21, ≤18, ≤15, ≤12 mmHg).

Main Results:

• Complete success rates varied from 26.2% (IOP ≤21 mmHg) to 54.6% (IOP ≤12 mmHg), with qualified success rates ranging from 45.7% to 88.6% at 36 months.
• Preoperative medication use negatively impacted survival, while 5-fluorouracil (5FU) injections combined with needling improved outcomes, particularly with lower IOP targets.

Conclusions:

• Trabeculectomy demonstrates high survival rates (77%-88.6%) in advanced OAG at 36 months when IOP is maintained at or below 15 mmHg or 12 mmHg.
• Achieving target IOP often requires medication and adjunctive procedures like needling with 5FU, with specific factors influencing different definitions of surgical success.