Long-term follow-up of 700 trabeculectomies

Background: A major focus of our study was to determine the value of postop erative intraocular pressure (IOP) in predicting the outcome of trabeculect omy (TE). Patients and methods: The medical charts of 547 patients undergoing glaucom a filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The eyes with congenital glaucoma and those treated with anti-metabolites were excluded. Results: Defining the qualified criteria for success of trabeculectomy as a n IOP less than or equal to 21 mm Hg throughout the entire study period, no evidence of progressive disc damage or further visual field loss, no decre ase in visual acuity and no additionally required surgical intervention due to glaucoma, there was a success rate of 44.4%. In 50% the tonometric fail ure took place within the first 34 days after trabeculectomy. No significan t difference in survival by sex (p=0.88), by age (p=0.53), surgical techniq ue, limbal versus fornix-based flap (p=0.28) and by type of glaucoma (p=0.2 6) was shown. But the patient group with prior argon laser trabeculoplasty had a significant lower success rate in terms of normalization of IOP (p=0. 03). There was no significant difference in the outcome of trabeculectromy between the first and the second eye. Conclusion: The identification of patients at risk of failure in terms of I OP in the early post-operative period is possible, thus, closer follow-up a nd early medical or surgical intervention may be indicated. Should trabecul ectomy be the therapy of first choice in the early stage of glaucoma and in case of failure in the first eye, this would allow options, such as the us e of antimetabolites in the second eye.