J Korean Ophthalmol Soc.  2021 Jun;62(6):812-819. 10.3341/jkos.2021.62.6.812.

The Long-term Outcomes of Mitomycin C Trabeculectomy of Phakic versus Pseudophakic Eyes of Patients with Exfoliative Glaucoma

• Gu WM
• Jeong S
• Cha SC

• KMID: 2516809
• DOI: http://doi.org/10.3341/jkos.2021.62.6.812

Abstract

Purpose
To determine whether previous cataract surgery affected the surgical prognosis of primary trabeculectomy with mitomycin- C (MMC) to treat exfoliative glaucoma (XFG).
Methods
This retrospective, consecutive study included 51 phakic eyes and 40 pseudophakic eyes of XFG patients that had previously undergone phacoemulsification via a temporal, clear corneal incision. All patients underwent primary trabeculectomy with MMC. Complete success was defined by an intraocular pressure (IOP) <18 mmHg and an IOP reduction ≥ 20% without any glaucoma medication. The cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors for surgical failure were analyzed using the Cox’s proportional hazards model.
Results
The mean follow-up period was 44.7 ± 28.0 months. The IOP had decreased by 4.5 mmHg in phakic eyes and 11.1 mmHg in pseudophakic eyes at the last visits after surgery (p = 0.005). The cumulative complete success rates were 78.4% at 1 year and 15.0% at 5 years for phakic eyes, and 85.0% and 31.5% for pseudophakic eyes. The complete success rates thus tended to be lower for phakic than pseudophakic eyes (p = 0.068). The risk factors associated with surgical failure were early postoperative hypotony (hazard ratio = 2.81, p = 0.016, complete success) and phakic status (hazard ratio = 1.97, p = 0.040, complete success).
Conclusions
The long-term outcomes of XFG patients whose pseudophakic eyes had undergone phacoemulsification prior to primary trabeculectomy with MMC were comparable to or better than those of patients with phakic eyes. Therefore, performing phacoemulsification first, followed by trabeculectomy, may be the better option if trabeculectomy is required by XFG patients with cataracts.

Keyword

Exfoliative glaucoma; Intraocular pressure; Phacoemulsification; Risk factor; Trabeculectomy