Comparative Trabeculectomy Outcomes between Repeat Trabeculectomy and Initial Trabeculectomy with Mitomycin C and Prognostic Factors for Surgical Failure
Keywords:
Failed trabeculectomy, Glaucoma surgery, Trabeculectomy, Mitomycin CAbstract
Background: Subconjunctival and episcleral fibrosis after glaucoma filtering surgery were the main causes of surgical failure. Therefore, repeated trabeculectomy was more likely to result in bleb failure.
Objective: To compare the efficacy between repeat and initial trabeculectomy, and study the prognostic factors for surgical failure.
Methods: A retrospective study of 123 glaucoma patients who underwent repeat or initial trabeculectomy with mitomycin-C between 1 July 2014 and 30 June 2022 and had a follow-up period of at least 12 months was reviewed. Main outcome measures included the rate of intraocular pressure reduction, number of glaucoma medications, surgical success, rate of bleb failure, and risk factors for failure. Statistical analysis included descriptive statistics, and multiple logistic regression analysis was used to identify risk factors for failure.
Result: Forty-five patients underwent repeat, and 78 patients underwent initial trabeculectomy. At 12 and 24 months postoperatively, the repeat group had higher intraocular pressure than the initial group (p = 0.0443 and 0.0369). At 12 months postoperatively, patients used medication, and the number of glaucoma medications in the repeat group was higher than in the initial group (p = 0.0450 and 0.0323). Complete success was higher in the initial group than in the repeat group, and bleb failure was more common in the repeat group, but the difference was not significant. Laser suture lysis and needling revision were risk factors for surgical failure, and the use of glaucoma eye drops after 3 months postoperatively was a protective factor for surgical failure.
Conclusions: Repeat trabeculectomy with mitomycin-C was effective in lowering intraocular pressure despite higher postoperative medication use, and the complication rate was not more than with the initial trabeculectomy.
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