PRIMARY TRABECULECTOMY IN YOUNG-ADULTS

Background. Younger patients are thought to have a poor surgical progn osis after trabeculectomy. The authors investigate the surgical outcom e of young adult patients after primary trabeculectomy. Methods: The a uthors reviewed the charts of all patients 15 to 40 years of age who h ad undergone primary trabeculectomy without the use of antimetabolites between January 1985 and January 1992 at Wills Eye Hospital. Failure was defined before the data collection as intraocular pressure (IOP) m ore than 25 mmHg without medication, IOP more than 21 mmHg with medica tion, or when further glaucoma surgery was indicated. Patients in whom preoperative IOPs were 21 mmHg or lower were classified as successes when the IOP was reduced by at least 33% of the preoperative measureme nt. Results: After a mean follow-up of 36.8 +/- 21.8 months, among the 31 patients with uncomplicated glaucomas (juvenile, pigmentary, low t ension, chronic angle closure), 26 (83.9%) were considered successes. After a mean follow-up of 42.3 +/- 26.5 months, among the 11 patients with other types of glaucoma (inflammatory, traumatic, associated with irido-corneal endothelial syndrome or mesodermal dysgenesis), 7 (63.6 %) were considered successes. Conclusions: The success rate of the unc omplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older patien ts. Primary trabeculectomy in young adults may have a favorable outcom e despite no antimetabolite therapy.