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. 1999 Jul;83(7):814–821. doi: 10.1136/bjo.83.7.814

Risk factors for failures of trabeculectomies performed without antimetabolites

H Mietz 1, B Raschka 1, G Krieglstein 1
PMCID: PMC1723106  PMID: 10381669

Abstract

AIMS—To assess the risk profile for the failure of trabeculectomies in a large group of patients who were selected to be operated on without the use of antimetabolites. This was done in an effort to find subgroups of patients who may not need antimetabolites for primary procedures.
METHODS—Consecutive patients scheduled for routine trabeculectomies were operated during a 4 year period and were followed up for at least 6 months postoperatively. Patients were regularly examined in the glaucoma unit and by their local ophthalmologists. Pre- and postoperative data were evaluated and success rates determined.
RESULTS—709 eyes of 566 patients were operated on; 534 eyes of 534 patients (94.4%) were finally evaluated. The mean follow up was 27.9 (SD 13.6) months with a range of 6-62 months. Success rates for complete surgical success ranged from 59% in the best group with pigmentary dispersion syndrome to 0% in the worst group with neovascular glaucoma. Success rates of patients with POAG, pseudoexfoliation, chronic angle closure, pigmentary dispersion syndrome, and dysgenetic glaucoma were similar. Failure rates ranged from 11% in the best group (pseudoexfoliation) to 80% in the worst group (neovascular glaucoma). Failure rates were high in complicated forms of glaucoma such as traumatic (30%), buphthalmus (40%), and uveitic (50%). For repeat trabeculectomies, the failure rate was 49% (20 of 41 eyes). The mean time until failure ranged from 2.7 months (traumatic) to 15.5 months (pigmentary dispersion syndrome) and was 4.9 months for repeat trabeculectomies.
CONCLUSION—Trabeculectomy performed in selected groups of patients has a favourable outcome without the use of antimetabolites. It may be possible to avoid antimetabolites in these groups of patients for primary procedures.



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Figure 1  .

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(A) Probability of surgical success in the subgroups with POAG, pseudoexfoliation, chronic angle closure, and pigmentary dispersion. The Kaplan-Meier survival plots showed no significant difference (p=0.45, log rank test). (B) Probability of surgical success in the subgroups with traumatic, uveitic, and neovascular glaucoma. The Kaplan-Meier survival plots showed no significant difference (p=0.30, log rank test). (C) Probability of surgical success in the subgroups with dysgenetic glaucoma, buphthalmus, and repeat trabeculectomies. The Kaplan-Meier survival plots showed a significant difference (p=0.017, log rank test).

Selected References

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