Analysis Of The Influencing Factors For Surgical Outcome Of Trabeculectomy With Mitomycin C For Neovascular Glaucoma

Backgrounds:Neovascular glaucoma (NVG) is an intractable eye disease and often leads to severe damage of structure and function of the eyeball, which results in severe and irreversible visual loss and acute pain. The most common causes of neovascular glaucoma are retinal ischemic diseases, including central retinal vein occlusion (CRVO), diabetic retinopathy (DR) and ocular ischemic syndrome. The prognosis of neovascular glaucoma is rather poor. We often need to take comprehensive treatments, including appropriate management of the causative diseases and controlling of the high intraocular pressure (IOP). The care of original diseases can effectively prevent NVG, which include PRP, vitrectomy combined with endophotocoagulation, etc. However, it is very difficult to control the IOP when iris and angle develop neovascularization (NV) which contribute to peripheral anterior synechia and an acute rise of IOP. Previous studies have shown that trabeculectomy with MMC for NVG is a good option. Our experience with NVG indicated that the surgical outcome was closely associated with the patients’own conditions. It is very meaningful for us to find out which factors contribute to the failure of trabeculectomy with MMC for NVG.Objective:To evaluate the influencing factors of trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG).Methods:We reviewed the medical records of 46 patients(32 male,14 female) with NVG who underwent trabeculectomy with MMC between April 1,2012 and March 31, 2014 at Shandong Provincial Hospital. The mean follow-up was 18.1±7.4 months, ranging from 6 to 29.4 months. A Kaplan-Meier survival curve analysis was used to summarize the cumulative probability of success and the relationship between the surgical outcome and the following factors:gender, age, etiology of NVG, preoperative intraocular pressure, previous cataract surgery, previous panretinal photocoagulation (PRP), and postoperative complications. The Cox proportional hazards model was used to analyse the effect of multivariate factors for surgical failure.Results:The success rate at 3,6,12,24 months after trabeculectomy was 93.5%,87.0%, 76.1% and 66.5% respectively. The success rate at 12 months for patients aged <55 years was 41.2%,72.9% for patients aged 55-65 years, and 88.2% for patients aged 65 years. The Cox proportional hazards model showed the age (RR,0.957; P=0.006) and postoperative hyphema (RR,2.649; P=0.045) were significantly associated with the surgical outcome.Conclusions:Younger age and postoperative hyphema are risk factors for failure of trabeculectomy combined with MMC in NVG. The surgical success rate increases with the age of the patient. Trabeculectomy combined with MMC is simple, safe and economical, especially for older patients. It is worth popularizing in basic-level hospitals. The surgical success rate can be improved by reducing postoperative hyphema.