The Factors Influencing the Outcome of Trabeculectomy in the Medically Uncontrolled Primary Angle-Closure Glaucoma

ABSTRACT

PURPOSE: To determine the factors that influence the outcome of trabeculectomy in eyes with medically uncontrolled primary angle-closure glaucoma (PACG). METHODS: The records of 70 eyes of 57 patients who had undergone trabeculectomy were reviewed. Success was defined as intraocular pressure of 21 mm Hg or less with or without antiglaucoma medications and no additional glaucoma surgery, phthisis, or loss of light perception. RESULTS: Postoperative success was obtained in 64 (91.4%) out of 70 eyes after a mean follow-up period of 28.9+/-23.7 months. The life-table success rate was 92.3% at 1 year and 88.0% at 5 years. Postoperative shallow anterior chamber was a significant risk factor for surgical failure (Cox proportional hazards regression analysis, hazard ratio, 27.8; 95% confidence interval, 2.6 to 297.5; p=0.005). Medically uncontrolled acute PACG in which trabeculectomy performed as an urgent surgical intervention, as opposed to medically uncontrolled chronic PACG, was a borderline risk factor (hazard ratio, 4.0; 95% confidence interval, 0.6 to 176.8; p=0.04). Factors found to be not significant included gender, refraction, visual acuity before surgery, preoperative number of antiglaucoma medications, presenting intraocular pressure, history of acute attack, previous peripheral iridectomy, mid-dilated pupil, glaukomflecken, iris atrophy, glaucomatous optic disc, and visual field damage. CONCLUSIONS: Postoperative shallow anterior chamber and medically uncontrolled acute PACG appear to have an adverse effect on the outcome of trabeculectomy. Success of trabeculectomy in PACG seems to be not related with the signs of damage from elevated intraocular pressure.