Outcome of repeat trabeculectomies: long-term follow-up

To assess medium-term to long-term outcomes of a cohort of repeat trabeculectomy augmented with mitomycin C (MMC).

A prospective evaluation of consecutive separate site repeat MMC-augmented trabeculectomies undertaken at a single institution between October 2000 and December 2012. Information regarding visual acuity (VA), intraocular pressure (IOP), visual field progression, postoperative interventions, surgery complications and success of surgery are presented.

Complete and qualified (ie, with or without glaucoma medication) success rates were presented on the basis of three levels of IOP control: ≤21, ≤17 and ≤14 mm Hg without hypotony or reoperation.

Fifty-six eyes of 56 patients were evaluated. Thirty-seven per cent of the cohort had a previously augmented trabeculectomy. Mean follow-up was 6.3±3.4 years. At 60-month follow-up, 56.1% of patients achieved complete success and 75.6% achieved qualified success at the ≤21 mm Hg target. Complete and qualified success rates were 53.7% and 73.2%, respectively at the ≤17 mm Hg target and 51.2% and 61.0%, respectively at the ≤14 mm Hg target. Mean preoperative IOP was 29.1±6.0 mm Hg. At the 60-month follow-up visit the mean IOP was 12.6±4.7 mm Hg. Requirement for topical medications dropped from a mean of 2.9 to 0.5 per patient. No medications were required in 68.3%.

Safe repeat trabeculectomy technique with antimetabolite titrated against the individual patients risk profile can result in improved results in the medium-term to long-term.