Risk factors for early filtration failure requiring suture release after primary glaucoma triple procedure with adjunctive mitomycin

Purpose: Postoperative release of scleral flap closure suture is useful in trabeculectomy combined with cataract surgery. We determined risk factors f or early filtration failure requiring suture release during the first month after primary glaucoma triple procedure. Methods: The medical records of 71 consecutive patients with primary open-a ngle glaucoma who under went a primary glaucoma triple procedure (primary t rabeculectomy, phacoemulsification, and posterior chamber intraocular lens implantation) were reviewed. Suture release had been performed in 24 of the patients for early filtration failure with postoperative intraocular press ure greater than the target value during the first postoperative month. The long-term filtration failure was defined according to 2 criteria based on medical dependency and requirement of additional surgical procedure for int raocular pressure control. Cox proportional hazards multivariate analysis w as performed to identify independent risk factors. Results: African American race (P =.02), more than 2 preoperative glaucoma drugs (P =.02), and intraocular pressure greater than 14 mm Hg during the f irst postoperative week (P =.006) were identified as significant independen t risk factors requiring suture release for filtration failure during the f irst postoperative month. Their significance was further confirmed by Kapla n-Meier survival analysis with Mantel-Cox log-rank test (P =.03, P =.02, an d P =.001, respectively). Conclusions: African American race, more than 2 preoperative medications, a nd intraocular pressure greater than 14 mm Hg in the first postoperative we ek are major independent risk factors for initial filtration failure requir ing suture release during the first month after primary glaucoma triple pro cedure. Presence of the risk factors may warrant a more aggressive antiprol iferative regimen and/or earlier suture release.