Primary Trabeculectomy in Young Adults: Long-term Clinical Results and Factors Influencing the Outcome

Abstract

To assess the long-term clinical outcome of primary trabeculectomy in young adults, and evaluate potential risk factors contributing to failure of filtering surgery. A retrospective review was carried out of the charts of all glaucomatous patients between the age of 15 to 45 years. These patients had no history of previous extra- or intraocular surgery and had undergone primary trabeculectomy without the use of antimetabolites from January 1988 to January 1995 at the University Eye Hospital of Cologne. A total of 51 eyes of 45 patients fulfilled the inclusion criteria. There were no drop-outs from follow-up. Mean follow-up was 5.2 years (range, 2.5 to 9.5 years). Outcome was defined as a success when postoperative intraocular pressure (IOP) was 21 mm Hg or lower. If further glaucoma medication was required the outcome was described as a qualified success, and when the patient was free of medication the outcome was considered a complete success. Using the Kaplan-Meier survival curve, cumulative life-table success rates were 88% at 1 year (n = 51), 82% at 3 years (n = 47), 76% at 5 years (n = 26), and 70% at 7 years (n = 22). At final visit 71% (n = 36) were classified as successes, with 54% (n=30) being successful without adjunct medication. Seventeen percent (n = 6) required additional topical medication. Previous laser trabeculoplasty and an IOP greater than 40 mm Hg during the course of the disease was found to adversely affect the outcome. Eyes with iridocorneal epithelialopathy (ICE) syndrome, Rieger's anomaly, and uveitic glaucoma failed more frequently than those with juvenile, pigmentary, and primary open-angle glaucoma (POAG). Younger age (< 30 years) was not associated with a lower success rate after controlling for glaucoma category. The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older adults. Primary trabeculectomy in young patients may have a favorable outcome even without antimetabolite therapy.