Hyphema is a risk factor for failure of trabeculectomy in neovascular glaucoma: a retrospective analysis

Abstract

BackgroundSeveral retinal ischemic diseases can cause neovascular glaucoma (NVG). Trabeculectomy with mitomycin C (MMC) is a relatively better treatment modality in the management of eyes with NVG than other glaucoma surgeries. The aim of this study was to investigate the factors that may influence the outcome of trabeculectomy with MMC for NVG.MethodsForty-nine NVG eyes from 43 patients (26 males and 17 females) underwent primary trabeculectomy with MMC. The mean follow-up period was 16.8 ± 8.1 months (range, 6 to 34 months). Twenty-one eyes of 21 patients received intravitreal bevacizumab (IVB) 3.6 ± 1.8 days before trabeculectomy with MMC. A Kaplan-Meier survival-curve analysis was used to summarize the cumulative probability of success. We examined the relationship between the surgical outcome and the following surgical factors: gender, age, history of panretinal photocoagulation, history of cataract surgery, history of vitrectomy, preoperative IVB, NVG in the fellow eye, and postoperative complications (hyphema, choroidal detachment, and formation of fibrin) by multivariate analysis.ResultsThe survival rate was 83.7% after 6 months, 70.9% after 12 months, and 60.8% after 24 months. The Kaplan-Meier survival curves showed no significant difference in the survival rate between the eyes with preoperative IVB (n = 21) and the eyes without preoperative IVB (n = 28) (p = 0.14). The multiple logistic regression analysis showed that postoperative hyphema (odds ratio, 6.54; 95% confidence interval, 1.41 to 35.97) was significantly associated with the surgical outcome (p = 0.02).ConclusionsPostoperative hyphema was significantly correlated with the outcome of trabeculectomy for NVG. There was no significant association between preoperative IVB and postoperative hyphema or the results of trabeculectomy.

Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital

“…A recent report by Nakatake et al . [25] showed that gross hyphema was statistically significantly associated with trabeculectomy failure in NVG patients.…”

Long-Term Outcomes and Prognostic Factors of Trabeculectomy following Intraocular Bevacizumab Injection for Neovascular Glaucoma

“…Less postoperative hemorrhagic complications and better surgical outcomes were anticipated because of the remarkable rapid and steady suppression of rubeosis after an intraocular injection of bevacizumab [ 17 – 19 ]. Indeed, postoperative hyphema was significantly less frequent when bevacizumab was used prior to trabeculectomy [ 9 , 11 ] or tube shunt surgery [ 20 – 22 ], although a statistically significant difference vs. control group was not achieved in other reports [ 6 , 10 , 12 , 23 ]. Furthermore, short-term surgical success rate was significantly better in eyes with preoperative bevacizumab injections in trabeculectomy [ 9 , 12 ] and tube shunt surgery [ 20 , 22 ].…”

“…Furthermore, short-term surgical success rate was significantly better in eyes with preoperative bevacizumab injections in trabeculectomy [ 9 , 12 ] and tube shunt surgery [ 20 , 22 ]. However, negative results were also reported for trabeculectomy [ 6 , 10 , 11 ] and tube shunt surgery [ 21 , 23 ]. The inconsistent results may stem from differences in the definition of surgical success, patient backgrounds and surgical procedures among different studies.…”

“…Surgical outcome of trabeculectomy is often unfavorable, even with the use of antimetabolites, due to hemorrhagic complications or marked inflammation that stem from active neovascularization [ 2 , 3 ]. Risk factors for surgical failure of trabeculectomy in eyes with NVG include younger age [ 2 , 4 ], previous pars plana vitrectomy (PPV) [ 3 , 4 ], extensive peripheral anterior synechia [ 3 ], pseudophakia [ 5 ] and postoperative hyphema [ 6 ].…”

Neovascular glaucoma: a review

“…Sisto et al [69] showed 55 % of success rate in a mean follow-up of 35 months with the use of postoperative 5-fluorouracil and 54 % of success rate in a mean follow-up 18 months with intraoperative mitomycin C. Still, compared to other types of glaucoma, NVG is a known risk factor for surgical failure [70]. Moreover, it has been suggested that a postoperative hyphema, a common complication in patients with NVG, may be associated with higher rates of trabeculectomy failure in NVG [71]. …”