LONG-TERM OUTCOMES OF INTRAOCULAR PRESSURE CONTROL AFTER TRABECULECTOMY
DOI:
https://doi.org/10.70520/kjms.v19i1.876Keywords:
Trabeculectomy, Glaucoma, Intraocular pressure, Postoperative complications, Long-term, IOPAbstract
Objective: To determine the long-term effect of trabeculectomy on intraocular pressure (IOP).
Methods: It was a cross-sectional study conducted at Department of Ophthalmology Hayatabad Medical Complex, Peshawar from May 2025 to October 2025. Eligible participants with at least nine months of follow-up were included in this study. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry before and after the trabeculectomy. Intraocular pressure control of ?18 mmHg with or without medications was termed as success. Baseline and postoperative IOP values at final follow-up were compared using paired t-test. Number of postoperative antiglaucoma medications and complications of the surgery were also noted.
Results: A total of 81 eyes of 75 patients, with a mean age of 37.09 ± 14.25 years, were included in this study. The mean follow-up duration of the whole study group was 30.53 ± 11.9 months. Out of total participants, 43 (57.3%) were females contributing 46 eyes (56.8%). Mean preoperative IOP was 32.65 ± 9.2 mmHg, which decreased to 14.6 ± 6.6 mmHg at the study endpoint, reflecting a mean reduction of 17.9 ± 8.2 mmHg (p<0.001). Successful IOP levels were achieved in 59 (72.8%) of the eyes; 41 (69.5%) achieved successful IOP levels without medications. Postoperative complications were observed in 23 (28.4%) of the eyes. No vision-threatening events were observed.
Conclusions: Trabeculectomy provided significant, sustained IOP reduction in the majority of the eyes over a mean follow-up of nearly three years, with an acceptable safety profile.
References
1. Geevarghese A, Wollstein G, Ishikawa H, Schuman JS. Optical Coherence Tomography and Glaucoma. Annu Rev Vis Sci. 2021;7:693–726. doi:10.1146/annurev-vision-100419-111350
2. Nasir AH, Bano M, Mahsood YJ. Outcomes of Trabeculectomy at a Newly Established Glaucoma Clinic in Khyber Pakhtunkhwa. Pak J Ophthalmol. 2021;38(1);48–51 doi:10.36351/pjo.v38i1.1306
3. Kratz A, Goldberg I, Koren T, Hadad A, Knyazer B, Lim R. Flow-Adjusted Trabeculectomy. J Clin Med. 2024;13(21):6609. doi:10.3390/jcm13216609
4. Singh K. Innovations to Make Glaucoma Surgery Safer. Delhi J Ophthalmol. 2022;32:78–81. doi:10.4103/dljo.dljo_85_23
5. Maheshwari D, Kanduri S, Rengappa R, Kadar M. Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol. 2020;68(4):615–9. doi:10.4103/ijo.IJO_963_19
6. Zweifel LAB, Storp JJ, Vietmeier FE, Danzer MF, Merté RL, Eter N, et al. Preserflo MicroShunt versus Trabeculectomy: Efficacy and Surgical Success within a Heterogenous Patient Cohort. Life (Basel). 2024;14:1171. doi:10.3390/life14091171
7. Jiang L, Eaves S, Dhillon N, Ranjit P. Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study. Clin Ophthalmol. 2018;12:995–1002. doi:10.2147/opth.s163247
8. Shahid E, Fasih U, Shaikh A. Outcome of Conventional Trabeculectomy in Terms of Intraocular Pressure and Visual Acuity in Primary Open Angle Glaucoma. Pak J Ophthalmol. 2020;36(4):386–390. doi:10.36351/pjo.v36i4.1086
9. Yuasa Y, Sugimoto Y, Hirooka K, Ohkubo S, Higashide T, Sugiyama K, et al. Effectiveness of trabeculectomy with mitomycin C for glaucomatous eyes with low intraocular pressure on treatment eye drops. Acta Ophthalmol. 2019;98(1):81–87. doi:10.1111/aos.14195
10. Shahid E, Fasih U, Shaikh A. Postoperative Complications of Trabeculectomy in Primary Open Angle Glaucoma Versus Primary Angle Closure Glaucoma. Pak J Ophthalmol. 2022;38(2):97–102. doi:10.36351/pjo.v38i2.1360
11. King AJ, Hudson J, Azuara-Blanco A, Burr J, Kernohant A, Homer T, et al. Evaluating primary treatment for people presenting with advanced glaucoma: 5-year results of the Treatment of Advanced Glaucoma Study. Ophthalmology. 2024;131:759–770. doi:10.1016/j.ophtha.2024.01.007
12. King AJ, Hudson J, Fernie G, Kernohan A, Azuara-Blanco A, Burr J, et al. Primary trabeculectomy for advanced glaucoma: pragmatic multicentre randomised controlled trial (TAGS). BMJ. 2021;373:n1014. doi:10.1136/bmj.n1014
13. Asrani SG, McGlumphy EJ, Al-Aswad LA, Chaya CJ, Lin S, Musch DC, et al. The relationship between intraocular pressure and glaucoma: An evolving concept. Prog Retin Eye Res. 2024;103:101303. doi:10.1016/j.preteyeres.2024.101303
14. Muralidharan S, Kumar S, Ichhpujani P, Dhillon HK. Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery. Indian J Ophthalmol. 2022;70:4206–4211. doi:10.4103/ijo.IJO_667_22
15. Verma-Fuehring R, Matlach J, Klink T, Hillenkamp J, Grehn F. Long-term outcomes of trabeculectomy versus canaloplasty in open-angle glaucoma - an 11-year follow-up of the TVC study cohort. BMC Ophthalmol. 2025;25:340. doi:10.1186/s12886-025-04183-9
16. Jahangir K, Awan LCAH, Farooq N, Rahman J ur, Zainab M, Aamir Khan M, et al. Long-Term Outcomes of Microinvasive Glaucoma Surgery (MIGS) vs.Trabeculectomy. J Neonatal Surg. 2024;13:1322–1327. doi:10.63682/jns.v13i1.9236
17. Ahmed IIK, Fea A, Au L, Ang RE, Harasymowycz P, Jampel HD, et al. A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma. Ophthalmology. 2020;127:52–61. doi:10.1016/j.ophtha.2019.04.034
18. Luo N, Liu M, Hao M, Xu R, Wang F, Zhang W. Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis. BMJ Open. 2023;13:e065921. doi:10.1136/bmjopen-2022-065921
19. Sun CQ, McSoley MJ, Lum F, Chang TC, Gedde SJ, Vanner EA. Tube Versus Trabeculectomy IRIS Registry Study: 1-Year Secondary Treatment Outcomes. Am J Ophthalmol. 2023;256:97–107. doi:10.1016/j.ajo.2023.08.011
20. Gedde SJ, Vinod K, Prum BE, Primary Tube Versus Trabeculectomy Study Group. Results from the Primary Tube Versus Trabeculectomy Study and translation to clinical practice. Curr Opin Ophthalmol. 2023;34:129–137. doi:10.1097/ICU.0000000000000928
21. Mazidah Zulfa MZ, Puspasari D, Rahmi FL. EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020–2022. Ophthalmol Indones. 2024;49:177–183. doi:10.35749/49p4dc89
22. Chiu HI, Su HI, Ko YC, Liu CJL. Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017. Br J Ophthalmol. 2022;106:362–367. doi:10.1136/bjophthalmol-2020-317303
23. Shabaninejad H, Homer T, Kernohan A, King AJ, Burr J, Azuara-Blanco A, et al. Is primary trabeculectomy cost-effective for patients with advanced primary open angle glaucoma? Results from the Treatment of Advanced Glaucoma Study economic model. Br J Ophthalmol. 2024;108:1210–1215. doi:10.1136/bjo-2023-323390
