Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

Abstract

Purpose Compare the efficacy and survival of trabeculectomy with intraoperative mitomycin-C (MMC) between Asian American and Caucasian patients in the same clinical setting. Methods In total, 29 Asian American patients (29 eyes) with trabeculectomies were matched case to case with 29 Caucasian patients (29 eyes) retrospectively. Matching criteria included age, glaucoma subtype, and preoperative intraocular pressure (IOP), gender, surgeon, ocular history, and glaucoma medications. Criteria of success included: (1) Final IOP 45 and o22 mmHg, (2) IOP reduction Z20%, or final IOP r10 mmHg, and (3) without additional glaucoma surgery, loss of light perception, or complication. Results Mean follow-up durations of Asian American and Caucasian group were 40.11722.5 months and 38.8717.7 months, respectively (P ¼ 0.81). At the final visits, IOP decreased from 18.776.1 to 10.974.0 mmHg (Po0.0001) in the Asian American group, and from 19.075.5 to 11.073.8 mmHg (Po0.0001) in the Caucasian group. There were no significant differences between the two groups in IOP levels at 6 months, 1 year, and final visits. The probabilities of trabeculectomy survival (continuing to meet definition of success criteria) at 12 and 48 months were 75.9 and 56.6% in the Asian American group and 82.8 and 66.6% in the Caucasian group, respectively. (P ¼ 0.46) There were no significant differences for rates of surgical success, failure, complication, vision decrease, hypotony, and cataract development. Patients who had episodes of hypotony had a higher rate of diagnosis of low-tension glaucoma subtype (P ¼ 0.02). Conclusions In a case-controlled comparison of an intermediate-term follow-up of trabeculectomy with intraoperative MMC, Asian American patients have a similar efficacy and survival probability as Caucasian patients.

Primary Open-Angle Glaucoma Preferred Practice Pattern® Guidelines

“…Estimates of success rates over time range from 31% to 88% in different populations and with varying definitions of success and failure. [374][375][376][377] The failure rate of trabeculectomy, without the use of adjunctive antifibrotic medications alone or combined with medical therapy, in a previously unoperated eye in the Advanced Glaucoma Intervention Study 66 reached approximately 30% in African American patients and 20% in Caucasian American patients over a 10-year period. 66 Even though long-term control is often achieved, many patients require further therapy or additional ocular surgery, with a higher associated longterm failure rate.…”

Primary Open-Angle Glaucoma Preferred Practice Pattern®

“…Estimates of success rates over time range from 31% to 88% in different populations and with varying definitions of success and failure. [435][436][437][438] The failure rate of trabeculectomy, without the use of adjunctive antifibrotic medications alone or combined with medical therapy, in a previously unoperated eye in the Advanced Glaucoma Intervention Study 82 reached approximately 30% in African American patients and 20% in Caucasian American patients over a 10-year period. 82 Medical treatment with benzalkonium chloride-preserved drugs may be a risk factor for surgical failure.…”

Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma

“…reported an acceleration of cataract/cataract surgery in 42.9% of eyes over 3–4 years in both Asian and Caucasian. [ 39 ] Tsai et al . noted that 54% of PACG needed cataract or further glaucoma surgery in 3 years after trabeculectomy.…”