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Trabeculectomy is the primary glaucoma surgery performed in patients whose disease is considered uncontrolled. Accepted risk factors for trabeculectomy failure include previous failed filtering surgery, aphakia or pseudophakia, neovascular glaucoma, uveitic glaucoma and paediatric glaucoma; some will also include race and youth.1 ,2 Neovascular glaucoma can be associated with proliferative diabetic retinopathy and the concomitant production of vascular endothelial growth factor. But should diabetes mellitus without retinopathy be considered a risk factor for trabeculectomy failure, even for trabeculectomy with adjunctive anti-fibrosis agents? Given the ongoing worldwide increase in the prevalence of diabetes,3 this is an important question, because the sheer number of diabetic persons could make diabetes the most commonly encountered risk factor for primary filtering surgery failure in the future, particularly in the developed countries of the world.
Law and colleagues4 report on a case–control study of diabetic eyes without retinopathy that underwent primary trabeculectomy by the same two surgeons. Both groups received adjunctive intraoperative mitomycin at the time of surgery for a relatively short duration (average about 1 min—about half the dose typically used by the American Glaucoma Society members in primary trabeculectomy).5 An intraocular pressure (IOP) greater than 15 mm Hg was considered a …