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  • Racial Differences in Long-Term Trabeculectomy Outcomes

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, October 2018

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    Evidence indicates that failure after tra­beculectomy without antimetabolites is more common among patients of Af­rican descent. Although adjunctive use of mitomycin C (MMC) improves the likelihood of success, data are lacking for patients of African descent who have undergone trabeculectomy combined with MMC. To identify prognostic indicators of failure, Nguyen et al. compared outcomes of initial trabe­culectomy plus MMC between patients of African and European descent and found that those of African descent were more likely to experience failure after trabeculectomy and bleb leak.

    In their study, 135 eyes from patients of African descent (n = 105) were matched to 135 eyes from patients of European descent (n = 117). Matching criteria included age (within 5 years), surgeon, lens status, and follow-up time (within 1 year).

    Three levels of qualified success were defined as follows:

    • For criteria A, final intraocular pres­sure (IOP) of ≤18 mm Hg with either ≥20% reduction in IOP or reduction of at least 2 medications.
    • For criteria B, a final IOP of ≤15 mm Hg and either ≥25% reduction in IOP or reduction of at least 2 medications.
    • For criteria C, a final IOP of ≤12 mm Hg or less and either ≥30% reduc­tion in IOP or reduction of at least 2 medications.

    Complete success was similarly de­fined with the additional requirement of no need for glaucoma medication(s).

    At 5 years, the qualified success rates for patients of African descent and those of European descent were as follows: For criteria A, 61% versus 67% (differ­ence, 7.3%, 95% confidence interval [CI], 4.4-10.4); for criteria B, 43% versus 60% (difference, 17.6%, 95% CI, 15.2-20.0); and for criteria C, 25% versus 40% (difference, 15.8%, 95% CI, 11.1-20.5). On multivariable Cox regression analyses, being of African descent was associated with higher fail­ure rate for criteria B and C for qual­ified success and with all criteria for complete success. The incidence of bleb leaks was higher in those of African descent (29 vs. 11 eyes); these patients also required additional glaucoma surgeries more often than did those of European descent (47 vs. 26 eyes).

    These results suggest new strate­gies to control wound healing after trabeculectomy are needed, and the role of nonfiltering glaucoma surgery should be explored in this subpopula­tion. (Also see related commentary by Paul Palmberg, MD, PhD, in the same issue.)

    The original article can be found here.