Long-term Follow-up of Initially Successful Trabeculectomy

Objective: The purpose was to study the long-term outcomes of primary trabeculectomies that were successful at 1 year. Design: A retrospective study of patients with various types of glaucoma who had trabeculectomies that were successful at 1 year and who had a follow-up of at least 10 years. Participants: There were 40 patients (40 eyes) who had primary trabeculectomies that were successful at 1 year and who had a follow-up range of 10 to 21 years. Intervention: Control of intraocular pressure (IOP) and disease progression was evaluated at 5, 10, and 15 years and at the last obtainable follow-up. Main Outcome Measures: Successful control of IOP was defined as IOP less than 21 mmHg or a reduction of 33% if preoperative IOP was less than 21 mmHg. Successful control of disease progression was defined as stable cup-disc ratios determined by examination, or color photographs or both, as well as stable visual fields. Results: If an eye was considered successful by IOP at 1 year, the probability of successful control of IOP was 82% at 5 years and 67% at 10 and 15 years. If an eye was considered successful by IOP at 1 year, the probability of successful control of disease progression at 5 years was 77%, at 10 years 61 %, and at 15 years 48%. If an eye did not require further glaucoma surgery at 1 year, the probability that it still would not need further surgery at 5 years was 90%, at 10 years 75%, and at 15 years 67%. Forty percent of eyes had cataract extraction by the time of last follow-up examination. Conclusions: Loss of IOP control and progression of glaucomatous damage occurs over time despite initial success at 1 year.