Primary Trabeculectomy in Young Adults

Abstract

Younger patients are thought to have a poor surgical prognosis after trabeculectomy. The authors investigate the surgical outcome of young adult patients after primary trabeculectomy. The authors reviewed the charts of all patients 15 to 40 years of age who had undergone primary trabeculectomy without the use of antimetabolites between January 1985 and January 1992 at Wills Eye Hospital. Failure was defined before the data collection as intraocular pressure (IOP) more than 25 mmHg without medication, IOP more than 21 mmHg with medication, or when further glaucoma surgery was indicated. Patients in whom preoperative IOPs were 21 mmHg or lower were classified as successes when the IOP was reduced by at least 33% of the preoperative measurement. After a mean follow-up of 36.8 +/- 21.8 months, among the 31 patients with uncomplicated glaucomas (juvenile, pigmentary, low tension, chronic angle closure), 26 (83.9%) were considered successes. After a mean follow-up of 42.3 +/- 26.5 months, among the 11 patients with other types of glaucoma (inflammatory, traumatic, associated with irido-corneal endothelial syndrome or mesodermal dysgenesis), 7 (63.6%) were considered successes. 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 patients. Primary trabeculectomy in young adults may have a favorable outcome despite no antimetabolite therapy.