Complications and outcomes of primary phacotrabeculectomy with mitomycin C in a multi-ethnic asian population

David Z Chen, Victor Koh, Chelvin Sng, Maria C Aquino, Paul Chew, David Z Chen, Victor Koh, Chelvin Sng, Maria C Aquino, Paul Chew

Abstract

Purpose: To determine the occurrence of intraoperative and postoperative complications up to three years after primary phacotrabeculectomy with intraoperative use of Mitomycin C (MMC) in primary open angle (POAG) and primary angle closure glaucoma (PACG) patients, and the effect of postoperative complications on surgical outcome.

Methods: Retrospective review of 160 consecutive patients with POAG (n = 105) and PACG (n = 55), who underwent primary phacotrabeculectomy with MMC at the National University Hospital, Singapore, from January 1, 2008 to December 31, 2010. Data was collected using a standardized form that included patient demographic information, ocular characteristics and postoperative complications, including hypotony (defined as intraocular pressure < 6 mmHg), shallow anterior chamber (AC) and hyphema.

Results: The mean age ± standard deviation (SD) of patients was 68.2 ± 8.2 years. No patient lost light perception during duration of follow-up. 77% of the postoperative complications occurred within the first month only. The commonest complications were hypotony (n = 41, 25.6%), hyphema (n = 16, 10.0%) and shallow AC (n = 16, 10.0%). Five patients (3.1%) required reoperation for their complications. Early hypotony (defined as hypotony < 30 days postoperatively) was an independent risk factor for surgical failure (hazard ratio [HR], 5.1; 95% CI, 1.6-16.2; p = 0.01). Hypotony with another complication was also a risk factor for surgical failure (p < 0.02).

Conclusions: Hypotony, hyphema and shallow AC were the commonest postoperative complications in POAG and PACG patients after phacotrabeculectomy with MMC. Most complications were transient and self-limiting. Early hypotony within the first month was a significant risk factor for surgical failure.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Kaplan Meier survival analysis of…
Fig 1. Kaplan Meier survival analysis of eyes with and without post-operative hypotony achieving surgical success (21mmHg).
Failure was defined as loss of visual acuity to no light perception, or first of 2 consecutive follow-up visits after 1 month in which the patient had persistent intraocular pressure (IOP) 21mmHg, or reoperation for glaucoma, whichever occurs first.
Fig 2. Kaplan Meier survival analysis of…
Fig 2. Kaplan Meier survival analysis of eyes with and without post-operative hypotony achieving surgical success (18mmHg).
Failure was defined as loss of visual acuity to no light perception, or first of 2 consecutive follow-up visits after 1 month in which the patient had persistent intraocular pressure (IOP) 18mmHg, or reoperation for glaucoma, whichever occurs first.
Fig 3. Kaplan Meier survival analysis of…
Fig 3. Kaplan Meier survival analysis of eyes with and without post-operative hypotony achieving surgical success (15mmHg).
Failure was defined as loss of visual acuity to no light perception, or first of 2 consecutive follow-up visits after 1 month in which the patient had persistent intraocular pressure (IOP) 15mmHg, or reoperation for glaucoma, whichever occurs first.

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