Perspective from George L. Spaeth, MD
Source:

Ophthalmology. 2012;119(4):694-702.

May 16, 2012
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Trabeculectomy survival rate 90% with additional medication at 20 years, study shows

Perspective from George L. Spaeth, MD
Source:

Ophthalmology. 2012;119(4):694-702.

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A study showed a high 20-year survival rate for trabeculectomies among a group of predominantly white patients.

“Patient age, preoperative topical medication use, glaucoma type, and glaucoma severity will independently influence this outcome,” the study authors said. “Trabeculectomy surgery is therefore a long-term solution to IOP control.”

The retrospective cohort analysis included 234 patients who had undergone 330 trabeculectomy procedures between 1988 and 1990. Patients were predominantly male and had an average age of 65 years.

Complete success was determined if IOP remained lower than 21 mm Hg in cases of high-tension glaucoma and IOP was reduced at least 20% with no additional medication in cases of normal-tension glaucoma. Qualified success was determined if IOP remained lower than 21 mm Hg in cases of high-tension glaucoma that required additional medication.

Study results showed that the overall trabeculectomy survival rate at 20 years was about 60% with no topical medication and about 90% with additional medication; 15% of eyes had become blind after 20 years.

Younger age and uveitic glaucoma correlated with risk of trabeculectomy failure. Pseudoexfoliation and aphakia were associated with progression to blindness.

Furthermore, patients using two or more topical medications and those with advanced visual field loss at the time of surgery had a greater risk of trabeculectomy failure and blindness.

 “After an initial rapid rate of failure in the first few years, a slower rate was recorded thereafter that did not appear to change over time despite the advent of newer topical therapies,” the authors said.