Prognostic factors in trabeculectomy with mitomycin C having history of previous glaucoma surgery
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CLINICAL INVESTIGATION
Prognostic factors in trabeculectomy with mitomycin C having history of previous glaucoma surgery Nanako Awai-Kasaoka • Toshihiro Inoue • Masaru Inatani • Yuji Takihara • Minako Ogata-Iwao Hidenobu Tanihara
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Received: 17 October 2012 / Accepted: 27 May 2013 / Published online: 3 August 2013 Ó Japanese Ophthalmological Society 2013
Abstract Purpose To evaluate the prognostic factors for surgical outcomes of subsequent trabeculectomy with mitomycin C (MMC) after prior incisional glaucoma surgery. Methods We reviewed medical records of a total cohort of 781 trabeculectomies with MMC, and selected 125 patients (125 eyes). The primary endpoints included persistent intraocular pressure (IOP) of C21 or \5 mmHg, the need for additional glaucoma surgery and deterioration of visual acuity to no light perception. Univariate and Multivariate analyses were performed by using the Cox proportional hazards model. Results The mean follow-up period was 26.8 months. The probabilities of success at 1, 2, and 3 years were 80.6, 72.2, and 70.6 %, respectively. Multivariate analysis showed that a shorter time interval between prior glaucoma surgery and subsequent trabeculectomy [relative risk (RR), 0.8867/year; P = 0.0090] and the number of prior trabeculectomies (RR, 2.2645; P = 0.0029) were significant prognostic factors for subsequent failure of trabeculectomy with MMC. Conclusion A short time period between prior glaucoma surgery and subsequent trabeculectomy and the number of prior trabeculectomies are associated with surgical failure of subsequent trabeculectomy with MMC.
N. Awai-Kasaoka T. Inoue (&) M. Ogata-Iwao H. Tanihara Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan e-mail: [email protected] M. Inatani Y. Takihara Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan
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Keywords Risk factor Trabeculectomy Repeat glaucoma surgery
Introduction Glaucoma is the second leading cause of vision loss in the world [1]. Lowering the intraocular pressure (IOP) is the classic approach—and the only one with positive results in large-scale clinical studies—to prevent progression of this disease. However, one study shows that the increase in dispensed prostaglandin analogues correlates with the decreasing number of trabeculectomies [2]. In general, trabeculectomy with mitomycin C (MMC) is widely used as surgical treatment of glaucoma to lower IOP, and initial trabeculectomy reportedly lowered IOP more effectively than did medical treatment [3–5]. Jay and Murray [3] report that 53 % of medically treated patients needed trabeculectomy after 4 years of follow-up because medical management failed to control the disease. Migdal et al. [4] found that trabeculectomy achieved the lowest mean IOP among three treatment groups: laser trabeculoplasty, medical therapy, and trabeculectomy. Moreover, Musch et al. [5] reported that initial trabeculectomy led to less visual field progression than medication. All these
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