Trabeculectomy less effective in UG versus POAG

Trabeculectomy with mitomycin C is less effective in maintaining reductions in IOP in eyes with uveitic glaucoma (UG) compared with eyes with primary open-angle glaucoma (POAG), according to a study published in the Journal of Glaucoma. In addition, these researchers found that eyes with UG more frequently require additional cataract surgery after trabeculectomy. Prognostic factors for the failure of trabeculectomy in eyes with UG include previous cataract surgery and granulomatous uveitis.

For this retrospective, consecutive, comparative cohort study, researchers at two Japanese clinical centres included 204 patients who underwent trabeculectomy with MMC between 1999 and 2008. Included were 101 eyes with UG and 103 eyes with primary open-angle glaucoma (POAG). Surgical failure was defined as IOPs of ≥ 21 mmHg or the requirement of an additional glaucoma procedure.

Kaplan-Meier survival curves for surgical failure were used to compare results from the two groups, and as was Cox proportional hazards modeling to determine the prognostic factors for surgical failure of trabeculectomy in UG eyes. Secondary outcomes included comparisons of the frequency of additional cataract surgery and other surgical complications after trabeculectomy between UG and PAGE eye.

Mean follow-up in the UG and POAG groups were 34.7 and 37.7 months. Subtypes of uveitis identified included granulomatous uveitis (n = 20) including sarcoidosis (n = 12), Vogt-Koyanagi-Harada disease (n = 5), and varicella zoster virus uveitis (n =3), Behçet’s disease (n = 10), Posner-Schlossman syndrome (n = 5), and other types of UG (n = 12). In addition, 54 eyes were diagnosed with idiopathic UG.

The 3-year probabilities of success after trabeculectomy were 71.3% in the UG group, and 89.7% in the POAG group (P = 0.0171). Multivariate modeling showed that UG eyes with previous cataract surgery (P = 0.0344) and granulomatous uveitis (P = 0.0106) were associated with surgical failure. UG eyes had more frequent cataract surgeries after trabeculectomy compared with POAG eyes, with the 3-year probability of additional cataract surgery of 62.6% in UG and 10.7% in POAG eyes (P

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