Original article
Success Rates of Trabeculotomy for Steroid-Induced Glaucoma: A Comparative, Multicenter, Retrospective Cohort Study

https://doi.org/10.1016/j.ajo.2010.11.028Get rights and content

Purpose

To evaluate the surgical outcomes of trabeculotomy for steroid-induced glaucoma.

Design

Multicenter, retrospective cohort study.

Methods

At 17 Japanese clinical centers, 121 steroid-induced glaucoma patients who underwent trabeculotomy between 1997 and 2006 were reviewed. Surgical failure was defined by the need for additional glaucoma surgery, deterioration of visual acuity to no light perception, or intraocular pressure ≥21 mm Hg (criterion A) and ≥18 mm Hg (criterion B). Surgical outcomes were compared with those of 108 primary open-angle glaucoma (POAG) patients who underwent trabeculotomy and 42 steroid-induced glaucoma patients who underwent trabeculectomy. Prognostic factors for failure were evaluated using the Cox proportional hazards model.

Results

The probabilities of success at 3 years for trabeculotomy for steroid-induced glaucoma vs trabeculotomy for POAG was 78.1% vs 55.8% for criterion A (P = .0008) and 56.4% vs 30.6% for criterion B (P < .0001), respectively. At 3 years, the success of trabeculotomy for steroid-induced glaucoma was comparable to trabeculectomy for steroid-induced glaucoma for criterion A (83.8%; P = .3636), but lower for criterion B (71.6%; P = .0352). Prognostic factors for failure of trabeculotomy for steroid-induced glaucoma were previous vitrectomy (relative risk [RR] = 5.340; P = .0452 on criterion A, RR = 3.898; P = .0360 for criterion B) and corticosteroid administration other than ocular instillation (RR = 2.752; P = .0352 for criterion B).

Conclusions

Trabeculotomy is effective for controlling intraocular pressure <21 mm Hg in steroid-induced glaucoma eyes.

Section snippets

Patient Selection and Surgical Procedures

We retrospectively reviewed the medical records of patients with steroid-induced glaucoma who underwent trabeculotomy or trabeculectomy with MMC and those with POAG who underwent trabeculotomy between January 1, 1997, and December 31, 2006, at the following 17 clinical centers in Japan: Kumamoto University Hospital (Kumamoto), Niigata University Medical and Dental Hospital (Niigata), University of Tokyo Hospital (Tokyo), Kanazawa University Hospital (Kanazawa), Gifu University Hospital (Gifu),

Patient Characteristics

In total, 163 patients (163 eyes) with steroid-induced glaucoma and 108 patients (108 eyes) with POAG satisfied the study criteria. All eligible patients were Japanese. Of the 163 eyes with steroid-induced glaucoma, 121 were included in the steroid-induced glaucoma with trabeculotomy group and 42 were included in the steroid-induced glaucoma with trabeculectomy group. Table 1 lists the characteristics of the enrolled patients.

The steroid-induced glaucoma with trabeculotomy group was

Discussion

This study compared the success rates of trabeculotomy for steroid-induced glaucomatous eyes with those for trabeculectomy for steroid-induced glaucoma eyes, and for trabeculotomy for POAG eyes. Trabeculotomy showed a significantly higher cumulative probability of success in steroid-induced glaucoma patients than POAG patients for both criterion A (P = .0008) and criterion B (P < .0001). The probability of success in steroid-induced glaucoma eyes treated with trabeculotomy was comparable to

Keiichiro Iwao, MD, PhD, received his doctorate from Saga University's Graduate School of Medicine, Saga, Japan, in 2009, which was based on mouse models of developmental glaucoma. He is currently assistant professor in the Department of Ophthalmology, Saga University Faculty of Medicine. He has been recognized by the Association for Research in Vision and Ophthalmology and was a recipient of the 2009 Kowa Travel Grant Award. His interests include glaucoma surgery and regeneration of the optic

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    Keiichiro Iwao, MD, PhD, received his doctorate from Saga University's Graduate School of Medicine, Saga, Japan, in 2009, which was based on mouse models of developmental glaucoma. He is currently assistant professor in the Department of Ophthalmology, Saga University Faculty of Medicine. He has been recognized by the Association for Research in Vision and Ophthalmology and was a recipient of the 2009 Kowa Travel Grant Award. His interests include glaucoma surgery and regeneration of the optic nerve.

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