Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

Felix Mathias Wagner, Alexander K Schuster, Keywan Kianusch, Julia Stingl, Norbert Pfeiffer, Esther M Hoffmann, Felix Mathias Wagner, Alexander K Schuster, Keywan Kianusch, Julia Stingl, Norbert Pfeiffer, Esther M Hoffmann

Abstract

Objective: To evaluate the long-term outcomes of trabeculectomy (TE) surgery in a large cohort with a minimum follow-up of 3 years.

Design: Retrospective cohort study.

Setting: University Eye Hospital, Germany.

Participants: Three hundred and seventy-nine patients with open-angle glaucoma underwent TE with mitomycin C (MMC) between January 2013 and February 2017 with a minimal follow-up of 3 years. Eligible patients were identified via an electronic surgical case register.

Interventions: All patients had undergone TE with MMC following a set surgical protocol. To assess the influence of cataract surgery following TE, eyes which underwent cataract surgery at least 6 months after TE were matched 1:3 by sex and age to eyes who did not undergo cataract surgery during the follow-up period.

Main outcome measures: Primary outcome was the proportion of surgical success based on intraocular pressure (IOP), surgical complications, the need for revision surgery, loss of light perception and the need for additional pressure-lowering medication.

Results: The mean follow-up time was 6 (±0.8, IQR: 5.4-6.5) years. Seventy-three per cent of eyes achieved qualified surgical success at the last follow-up (IOP≥5 mm Hg and ≤18 mm Hg, without surgical complications or complete loss of vision) but necessitated additional medical therapy, complete surgical success with no additional medical therapy was achieved in 69% of eyes. There was no significant difference in the success probability between eyes that had undergone cataract surgery after TE and those that had not (p=0.45).

Conclusions: The results demonstrate a high and stable success rate of TE after a mean follow-up time of approximately 6 years, that is, not affected by later cataract surgery.

Keywords: cataract and refractive surgery; glaucoma; ophthalmology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Kaplan-Meier survival analysis of complete success in all cases.
Figure 2
Figure 2
Scattergram showing preoperative and last postoperative intraocular pressure (IOP), illustrated by frequency; blue dashed line displays 20% IOP-reduction.
Figure 3
Figure 3
Comparison of Kaplan-Meier survival analysis for the matched cohort of eyes with and without cataract surgery at least 6 months after trabeculectomy (TE).

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