Outcomes of Primary Trabeculectomy From Two Same-centre Cohorts 10 Years Apart

Precis: Trabeculectomy can effectively lower intraocular pressure (IOP). A more junior surgeon profile is emerging. Mitomycin C (MMC) has replaced 5-fluorouracil (5-FU) intraoperatively with comparable success rates and a decrease in postoperative antimetabolite administration. Purpose: We compare 2-year outcomes for primary trabeculectomy in 2 cohorts, 10 years apart, performed at a large UK teaching hospital. Methods: Consecutive case series of trabeculectomies at Manchester Royal Eye Hospital between 2004-2005 (Cohort 1/C1) and 2014-2015 (Cohort 2/C2). Preoperative and postoperative data was collected for IOP outcomes and complications. Success was defined as IOP >= 6 and <= 21, <= 18, <= 16, <= 14, or <= 12 mm Hg with/without a >= 20% decrease from preoperative IOP. The need for and absence of postoperative antihypertensive medication defined qualified and complete success, respectively. Results: A total of 186 cases were analyzed [52 (C1), 134 (C2)]. Mean preoperative IOP was 24 +/- 10 mm Hg (C1) and 21 +/- 7 mm Hg (C2) (P=0.01). Overall, 34 (79%), 33 (77%), 33 (77%), 29 (67%), and 25 (58%) patients in C1 and 88 (70%), 82 (65%), 73 (58%), 64 (51%), and 40 (32%) patients in C2 achieved complete success for IOP <= 21 mm Hg (P=0.33), <= 18 mm Hg (P=0.22), <= 16 mm Hg (P=0.04), <= 14 mm Hg (P=0.09), or <= 12 mm Hg (P=0.004). Similarly, 43 (93%), 40 (87%), 40 (87%), 35 (76%), and 27 (59%) in C1 and 123 (98%), 116 (92%), 106 (84%), 87 (69%), and 58 (49%) in C2 achieved qualified success (P=0.34, 0.37, 0.83, 0.48, and 0.19). In all, 32 (74%), 31 (72%),31 (72%), 28 (65%), and 24 (56%) in C1 and 64 (51%), 63 (50%), 61 (48%), 54 (43%), and 39 (31%) in C2 achieved complete success with >= 20% reduction from preoperative IOP and IOP of <= 21 mm Hg (P=0.01), <= 18 mm Hg (P=0.02), <= 16 mm Hg (P=0.01), <= 1 mm Hg (P=0.02), or <= 12 mm Hg (P=0.006). By same definition, 37 (80%), 36 (78%), 36 (78%), 33 (72%), and 26 (57%) in C1 and 94 (75%), 93 (74%), 90 (71%), 75 (60%), and 58 (46%) in C2 achieved qualified success (P=0.55, 0.69, 0.48, 0.20, and 0.30). Mean IOP at 2 years was 13 +/- 5 mm Hg (C1) and 13 +/- 4 mm Hg (C2) (P=0.35). Overall, 62% had intraoperative 5-FU in C1; only MMC was used in C2 (P<0.0001). Postoperative 5-FU was administered in 54% versus 22% in C1 and C2, respectively (P<0.0001). Needling rates were not statistically different [42% (C1), 54% (C2)] (P=0.22). Conclusions: Trabeculectomy is effective in lowering IOP with success comparable across various definitions. MMC replaced 5-FU as intraoperative antimetabolite resulting in reduced need for postoperative antimetabolite but not increased complications.

Automated summary

Trabeculectomy effectively lowers intraocular pressure, with success rates comparable across various definitions. The use of MMC instead of 5-FU reduces the need for postoperative antimetabolite administration without increasing complications. A more junior surgeon profile is emerging in performing this surgery.