Study illuminates risk factors for trabeculectomy failure in African-Caribbean patients

This prospective study identified three major independent factors influencing trabeculectomy failure after three years in the U.K. African-Caribbean population: preoperative use of acetazolamide, pseudophakic status, and higher preoperative IOP. The presence of one or more of these factors may warrant a more aggressive preoperative approach, variation of intraoperative techniques, and/or an intensive postoperative management regimen to improve trabeculectomy survival rates in this high-risk population.

The authors evaluated baseline factors influencing success of trabeculectomy with mitomycin C in 47 African-Caribbean patients with glaucoma. Success was defined as IOP ≤ 21 mmHg with or without glaucoma medication.

Trabeculectomy success at 36 months was significantly decreased with the use of preoperative acetazolamide, pseudophakic status and higher preoperative IOP (P < 0.05). Previous cataract surgery was also a strong independent risk factor for trabeculectomy failure, but only if failure was defined as ≤ 18 mmHg. This suggests that the increased fibrotic response induced by cataract surgery is a risk factor for failure only when achieving lower target IOPs.