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. 2025 Apr 17:19:1299-1311.
doi: 10.2147/OPTH.S518659. eCollection 2025.

Long-Term Surgical Outcome of Trabeculectomy with Mitomycin C: A Comparison Between Primary and Secondary Glaucoma in Thailand

Ployroung Arampinyokul #  1   2 , Kulawan Rojananuangnit #  1
Affiliations

Long-Term Surgical Outcome of Trabeculectomy with Mitomycin C: A Comparison Between Primary and Secondary Glaucoma in Thailand

Ployroung Arampinyokul et al. Clin Ophthalmol. .

Abstract

Purpose: This study aimed to evaluate the long-term surgical outcomes of trabeculectomy with mitomycin C (MMC) and identify factors associated with surgical failure in Thai patients with primary and secondary glaucoma.

Methods: This retrospective study included 421 eyes from 397 patients with glaucoma who underwent trabeculectomy with MMC from January 1, 2012, to December 31, 2015. The patients' demographics, baseline characteristics, ocular parameters, and postoperative outcomes were analyzed. Surgical success was classified into complete success (IOP = 4-21 mmHg without anti-glaucoma medication), qualified success (IOP = 4-21 mmHg with medication), and failure (IOP >21 mmHg or <4 mmHg). Factors associated with surgical failure were assessed using Cox regression analysis.

Results: The cumulative probability of complete or qualified success at 8 years was 65.9% (95% CI: 59.9%, 71.9%); however, a significantly higher success rate was observed in the primary glaucoma group (75.1%) than in the secondary glaucoma group (47.4%) (p < 0.001). The secondary glaucoma group, particularly those with secondary closed-angle glaucoma, had the lowest success rates. Preoperative IOP, number of anti-glaucoma medications, and visual acuity were significantly different between the two groups. Etiologic factors associated with surgical failure included pseudo-exfoliation glaucoma (adjusted HR 3.23), neovascular glaucoma (adjusted HR 2.87), and secondary angle closure glaucoma (adjusted HR 2.62). Late complications were more prevalent in patients with secondary glaucoma than in those with primary glaucoma and included decreased visual acuity (5.43% vs 10.29%), hypotony (0.26% vs 1.14%), corneal decompensation (1.82% vs 3.40%), and bleb-related infection (0.19%).

Conclusion: Trabeculectomy with MMC remains an effective surgical option for primary glaucoma, demonstrating better long-term outcomes compared to its outcomes in patients with secondary glaucoma. Risk factors for surgical failure include specific glaucoma etiologies. These findings would personalize management strategies to optimize surgical approaches based on predictive factors for surgical success.

Keywords: close-angle glaucoma; neovascular glaucoma; open-angle glaucoma; postintraocular surgery glaucoma; pseudoexfoliation glaucoma; uveitic glaucoma.

Plain language summary

The study looked at how well a type of eye surgery called trabeculectomy works for people with glaucoma, a condition that causes high pressure in the eye. We reported how successful the surgery was over 8 years and what might make it more likely to fail. The study found that trabeculectomy surgery works better for people with primary glaucoma than for those with secondary glaucoma (glaucoma caused by other health issues). After 8 years, about 75% of primary glaucoma patients had successful results, while only 47% of secondary glaucoma patients did. Secondary glaucoma patients also had more postsurgery problems, like vision loss and infections. These findings would help doctors tailor treatment plans and choose the best surgical approach based on factors that predict surgery success.

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Conflict of interest statement

The author(s) report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cumulative probability of complete or qualified success of trabeculectomy with Mitomycin C between the primary and secondary glaucoma groups.
Figure 2
Figure 2
Intraocular pressure and number of anti-glaucoma medication comparing at baseline and postoperative follow-up between the primary and secondary glaucoma group.
Figure 3
Figure 3
Cumulative probability of complete or qualified success of trabeculectomy with Mitomycin C in the primary open-angle glaucoma, primary closed-angle glaucoma, and juvenile open-angle glaucoma groups.
Figure 4
Figure 4
Cumulative probability of complete or qualified success of trabeculectomy with Mitomycin C in cases of neovascular glaucoma, uveitis glaucoma, postsurgical related glaucoma, secondary closed-angle glaucoma, and traumatic glaucoma.
See this image and copyright information in PMC

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References

    1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081–2089. doi:10.1016/j.ophtha.2014.05.013 - DOI - PubMed
    1. Isipradit S, Sirimaharaj M, Charukamnoetkanok P, et al. The first rapid assessment of avoidable blindness (RAAB) in Thailand. PLoS One. 2014;9(12):e114245. doi:10.1371/journal.pone.0114245 - DOI - PMC - PubMed
    1. Bourne RR, Sukudom P, Foster PJ, et al. Prevalence of glaucoma in Thailand: a population based survey in Rom Klao District, Bangkok. Br J Ophthalmol. 2003;87(9):1069–1074. doi:10.1136/bjo.87.9.1069 - DOI - PMC - PubMed
    1. Jenchitr W, Hanutsaha P, Iamsirithaworn S, Parnrat U, Choosri P. The national survey of blindness low vision and visual impairment in Thailand 2006–2007. Thai J Pub Hlth Ophthalmol. 2007;21(1):10.
    1. The advanced glaucoma intervention study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators. Am J Ophthalmol. 2000;130(4):429–440. doi:10.1016/s0002-9394(00)00538-9 - DOI - PubMed

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