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Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017
  1. Hsun-I Chiu1,
  2. Huan-I Su2,
  3. Yu-Chieh Ko1,3,
  4. Catherine Jui-Ling Liu1,3
  1. 1Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
  2. 2Department of Ophthalmology, En Chu Kong Hospital, New Taipei City, Taiwan
  3. 3Medicine, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to MD Catherine Jui-Ling Liu, Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan; jlliu{at}vghtpe.gov.tw; MD Yu-Chieh Ko; koyc{at}vghtpe.gov.tw

Abstract

Aims To determine long-term outcomes and risk factors for failure after mitomycin C (MMC)-augmented initial trabeculectomy (IT) in Taiwanese patients.

Methods We reviewed medical records of patients with glaucoma undergoing IT during December 2006–December 2016. We defined complete success as an intraocular pressure (IOP) of >5 or ≤21 mm Hg or IOP reduction of ≥20% from baseline without supplemental medications and qualified success as the aforementioned IOP levels with or without supplemental medications. Kaplan-Meier survival and Cox proportional analyses evaluated success rates and risk factors for failure, respectively.

Results We enrolled 190 patients (237 eyes; mean age: 54.0±15.3 years; mean postoperative follow-up period: 68.4±35.1 months). Mean IOP and glaucoma medications decreased from 22.2±10.8 to 14.4±5.2 mm Hg (p<0.001) and 3.0±0.7 to 1.8±1.2 (p=0.015), respectively, at the last visit. Cumulative qualified success rates were 93.9%, 93.0%, 86.5% and 67.1% at the 1, 2, 5 and 10 years follow-up, respectively; however, only 7.7% of the eyes reached complete success at the last visit. Eyes with poor preoperative visual acuity were associated with low qualified success rates (HR=1.689, p=0.027); patients aged >70 years had higher complete success rates than did those aged ≤70 years. Five cases (2.11%) exhibited bleb-associated complications.

Conclusion Despite satisfactory long-term success rates, most eyes needed medication for IOP control, supporting the notion of predisposed scarring vitality in patients of Chinese ethnicity following MMC-augmented trabeculectomy.

  • glaucoma
  • intraocular pressure

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Footnotes

  • H-IC and H-IS are joint first authors.

  • Y-CK and CJ-LL are joint senior authors.

  • H-IC and H-IS contributed equally.

  • Y-CK and CJ-LL contributed equally.

  • Contributors CJ-LL and Y-CK were responsible for the study conception. HI-C and H-IS contributed to the data acquisition and analysis. HI-C contributed to the data interpretation and manuscript drafting.

  • Funding This work was supported by Ministry of Science and Technology, Taiwan (MOST 108-3011-F-075-001). The funding source had no role in the study design, analyses, data interpretation or decision to submit results.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board for Human Research of Taipei Veterans General Hospital approved our study (2018-12-001CC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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