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Trabeculectomy survival rate 90% with additional medication at 20 years, study shows
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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.
Perspective
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George L. Spaeth, MD
This study presents nothing new. This study presents hugely important, highly relevant information. These two sentences seem to be contradictory, yet they are both true. Watson previously reported similar results, as did I. Yet current dogma states that around half of trabeculectomies fail by 5 years. The discrepancy between the results of Watson’s study (which are in agreement with my personal experience) and results suggesting rapid failure of trabeculectomy must have an explanation. Possibly this relates to the population served at Addenbrooke’s Hospital in Cambridge, England. However, it is more likely that it relates to the technique of the surgery. We desperately need to know the details of how the trabeculectomies that form the basis of this study were performed. My hunch is that few had fornix-based conjunctival flaps.
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Ophthalmology. 2012;119(4):694-702.
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