YOUNG PATIENT TRABECULECTOMY - ASSESSMENT OF RISK-FACTORS FOR FAILURE

Background. Various risk factors for failure of glaucoma filtering sur gery, including young age, have been suggested. Methods: A retrospecti ve study of 113 trabeculectomies in 113 patients, ranging in age betwe en 11 and 49 years (mean, 33.3 +/- 10.5 years), was carried out to det ermine the influence of these risk factors in young patients. Results: A successful outcome (intraocular pressure [IOP] less-than-or-equal-t o 21 mmHg without antiglaucoma treatment), assessed by life-table anal ysis, was achieved in 54% of trabeculectomies after 38 months (mean fo llow-up, 36.7 +/- 29.7 months). Previous ocular surgery (e.g., glaucom a filtering, cataract, or conjunctival surgery) and previous laser the rapy (i.e., argon laser trabeculoplasty and YAG laser iridotomy) both significantly reduced the success rate. An IOP greater than 40 mmHg du ring the course of the disease was found to adversely affect the outco me. No direct correlation between success rate and age and no racial d ifference were demonstrated. Success rates for specific diagnoses were not significantly different. Postoperative subconjunctival injections of 5-fluorouracil (5-FU) did not significantly improve the success ra te. A Cox regression analysis of various prognostic variables identifi ed previous cataract surgery (hazard ratio, 4.4), argon laser trabecul oplasty (hazard ratio, 3.4), previous glaucoma filtering surgery (haza rd ratio, 2.5), nonfiltering glaucoma surgery (hazard ratio, 2.2) and IOP greater than 40 mmHg (hazard ratio, 2.4) to be the major risk fact ors for glaucoma filtering surgery failure. Conclusion: A majority (74 %) of the patients in our series had at least one of these risk factor s, thus explaining why young patients, in general, have lower success rates for trabeculectomy. Ophthalmology 1993;100:928-939