Risk factors for failures of trabeculectomies performed without antimetabolites
Holger Mietz, Birgit Raschka, Günter K Krieglstein
Department of Ophthalmology, University
of Cologne, Cologne, Germany
Correspondence to: H Mietz, MD, Department of Ophthalmology, University of Cologne, 50924 Koeln, Germany.
Accepted for publication 1
March 1999
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.
METHODSConsecutive 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.
RESULTS709 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.
CONCLUSIONTrabeculectomy 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.
© 1999 by British Journal of Ophthalmology
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