Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China:a 325 eyes analysis

AIM:To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C(MMC)in Southwest Chinese patients.METHODS:A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)>5 and≤21 mm Hg and 20%reduction of IOP compared to preoperative,without IOP-lowering medications.A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications.The primary outcomes were IOP,the number of IOP-lowering medications,and cumulative success rate.The secondary outcomes included best corrected visual acuity(BCVA),mean deviation(MD)of visual field,major complications,and risk factors for surgical failure.RESULTS:A total of 325 eyes of 261 glaucomatous patients had been included in our study.Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg(P<0.0001)and 3.0±0.9 to 0.9±1.0(P<0.0001),respectively,at the last visit.The cumulative complete success rate and qualified success rate were 77.8%and 92.0%at 1-year follow-up,and 47.2%and 77.7%at 3-year follow up.There were no significant differences in surgical outcomes between primary angle-closure glaucoma(PACG)and primary open angle glaucoma(POAG).In PACG patients,the success rates of trabeculectomy were comparable with those of phacotrabeculectomy.Hypertension(HR=1.904,P=0.011),encapsulated bleb(HR=2.756,P<0.001),and more preoperative topical medications(HR=2.475,P=0.008)were risk factors for surgical failure.CONCLUSION:The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0%at 1-year,and 77.7%at 3-year follow up.Hypertension,encapsulated bleb,and more preoperative topical medications are associated with surgical failure.

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China:clinical characteristics and outcomes

AIM:To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy.METHODS:Pediatric ocular trauma patients(aged 14 y or younger)who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively.Age,gender,mechanism of injury,final visual acuity(VA),and prognostic factors were analyzed.RESULTS:A total of 139 eyes in 139 pediatric patients were included in the study.The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1.There were 104(74.8%)open globe injuries and 35(25.2%)closed globe injuries.The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects(43.9%).After vitrectomy,116 patients had favorable anatomic outcome at the last follow-up,and 30 eyes(21.6%)achieved VA of 20/200 or better.Following univariate analysis,we found zone III injuries(P=0.021),poor initial VA(P=0.005),endophthalmitis(P=0.024),and recurrent retinal detachment(P<0.001)were poor prognostic factors for pediatric ocular trauma.After Logistic regression analysis,the poor initial VA(odds ratio:8.276,95%CI:1.597-42.897,P=0.012)and recurrent retinal detachment(odds ratio:6.455,95%CI:2.372-17.562,P<0.001)were significantly correlated with unfavorable vision outcome in pediatric ocular trauma.CONCLUSION:The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes,but VA improvement is not as good as anatomic outcomes.Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.