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To elucidate the long-term outcomes and prognostic factors for trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG).A retrospective, consecutive, comparative cohort study was conducted with 204 patients who underwent trabeculectomy with MMC between 1999 and 2008 at 2 Japanese clinical centers. The study group included 101 eyes with UG and 103 eyes with primary open-angle glaucoma (POAG). Surgical failure was defined as intraocular pressure levels of ≥21 mm Hg or an additional glaucoma surgery. Kaplan-Meier survival curves for surgical failure were compared between UG and POAG eyes, and prognostic factors for surgical failure of trabeculectomy in UG eyes were analyzed by the Cox proportional hazards model. Secondary outcome measures included comparisons of the frequency of additional cataract surgery and other surgical complications after trabeculectomy between UG and POAG eyes.The mean follow-up periods (±SD) were 34.7±37.9 and 37.7±34.7 months (median, 24.0 and 27.4 mo) for UG and POAG, respectively. The subtypes of uveitis were granulomatous uveitis (n=20) including sarcoidosis (n=12), Vogt-Koyanagi-Harada disease (n=5) and varicella zoster virus uveitis (n=3), Behçet disease (n=10), Posner-Schlossman syndrome (n=5), and other types of UG (n=12). Fifty-four eyes were diagnosed with idiopathic UG. The 3-year probabilities of success after trabeculectomy were 71.3% and 89.7% for UG and POAG, respectively (P=0.0171). A multivariable model showed that UG eyes with previous cataract surgery [relative risk (RR)=2.957, P=0.0344)] and granulomatous uveitis (RR=3.805, P=0.0106) were associated with surgical failure. UG eyes experienced more frequent cataract surgeries after trabeculectomy than POAG eyes: the 3-year probabilities of additional cataract surgery of 62.6% and 10.7% for UG and POAG, respectively (P0.0001). There was no significant difference in the frequency of surgical complications such as bleb leakage, hypotensive maculopathy, severe anterior-chamber hemorrhage, and infectious endophthalmitis.Trabeculectomy with MMC was less effective in maintaining intraocular pressure reduction in UG eyes than in POAG eyes. The prognostic factors for surgical failure of trabeculectomy in UG eyes were previous cataract surgery and granulomatous uveitis. In addition, UG eyes after trabeculectomy more frequently required additional cataract surgery.

PURPOSE To determine the risk factors for hyphema after trabeculectomy with mitomycin C (MMC). PATIENTS AND METHODS In total, 420 patients (420 eyes) with glaucoma who underwent trabeculectomy with MMC between June 1, 2005 and December 31, 2010 at Kumamoto University Hospital, Japan, were retrospectively evaluated. Hyphema after trabeculectomy was defined as the niveau formed by bleeding in the anterior chamber. Logistic multivariable analysis was applied to determine the risk factors for hyphema. RESULTS Of the 420 patients, 104 (24.8%) had hyphema. Neovascular glaucoma [NVG; odds ratio (OR)=2.404; P=0.0017] and anticoagulant or antiplatelet medication at trabeculectomy (OR=2.143; P=0.0274) were significant risk factors for hyphema. Of the 108 NVG patients, 43 (39.8%) had hyphema after trabeculectomy with MMC. In the subgroup analysis of NVG patients, neovascularization in the anterior chamber angle at trabeculectomy (OR=5.7886; P=0.0163) and anticoagulant or antiplatelet medication at trabeculectomy (OR=3.3325; P=0.0450) were risk factors for hyphema, whereas preoperative intravitreal bevacizumab injection significantly reduced the hyphema risk (OR=0.3568; P=0.0275). CONCLUSIONS The risk factors for hyphema after trabeculectomy with MMC are independently associated with NVG and anticoagulant or antiplatelet medication. Neovascularization in the anterior chamber at trabeculectomy and anticoagulant or antiplatelet medication enhance the risk of hyphema developing in NVG patients, whereas preoperative injection of intravitreal bevacizumab reduces the likelihood.

To investigate the rate and risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR).Five hundred and twelve patients (512 eyes) with PDR who underwent vitrectomy between January 1, 2003 and June 30, 2009 at Kumamoto University Hospital, Japan, were retrospectively evaluated. Postoperative NVG was defined as neovascularization in the anterior segment and intraocular pressure (IOP) ≥ 22 mm Hg after vitrectomy. Kaplan-Meier survival analysis was applied to calculate the rate of NVG after vitrectomy. Risk factors for NVG after vitrectomy were identified by multivariable analysis using the Cox proportional hazards model.The mean follow-up period was 422 days. Twenty-seven of 512 patients (5.3%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 6.0% and 7.1%, respectively. Male sex [relative risk (RR)=4.247; P=0.0032), younger age (RR=0.956/y; P=0.0237), higher baseline IOP (RR=1.203/mm Hg; P=0.0335), preoperative neovascularization in the anterior chamber angle (RR=8.899; P0.0001), and presence of NVG in the fellow eye (RR=5.355; P=0.0013) were significant risk factors for postoperative NVG.The frequency of NVG in PDR eyes within 1 year after vitrectomy was estimated as 7.1%. The risk is independently associated with male sex, younger age, higher baseline IOP, preoperative neovascularization in the angle, and NVG in the fellow eye.

To evaluate the effects of intravitreal bevacizumab (IVB) before mitomycin C trabeculectomy (MMCT) for neovascular glaucoma (NVG).The study is a retrospective, comparative, consecutive case series. The study group consisted of 57 eyes from 50 patients with NVG who underwent a first MMCT: 33 eyes were treated with MMCT alone between June 1, 2005 and May 17, 2007 (Control Group); and, 24 eyes were treated with a combination of IVB and MMCT after May 18, 2007 (IVB Group). Surgical complications, intraocular pressure (IOP), and the probability of success were compared between the 2 groups. Surgical failure was defined as IOP ≥22 mm Hg for 2 consecutive follow-up visits, a deterioration of visual acuity to no light perception, or additional glaucoma surgeries.There were no significant differences in preoperative data between the groups. Hyphema associated with MMCT occurred significantly less often in the IVB Group (P=0.006). IOPs at 7 and 10 days after MMCT were significantly lower in the IVB Group (P=0.01 and 0.02, respectively). However, Kaplan-Meier survival-curve analysis showed the probability of success 120, 240, and 360 days after MMCT of 87.5%, 79.2%, and 65.2% in the IVB Group, and 75.0%, 71.9%, and 65.3% in the Control Group. No significant difference in survival times was found between the groups (P=0.76).IVB before MMCT reduced hyphema associated with MMCT for NVG. IVB provided further IOP reduction immediately after MMCT, but did not significantly improve surgical outcomes over longer periods.

To investigate the dependence upon intraocular pressure (IOP) of the progression of visual field defects in eyes with primary open-angle glaucoma (POAG), in which the mean IOP was maintained ator =21 mm Hg.This study involved 100 eyes with POAG, which were followed up foror =5 years. The mean IOP levels were maintained ator =21 mm Hg during the follow-up period. The relationship between the IOP and the progression of visual field defects, which was scored using the Advanced Glaucoma Intervention Study criteria, was investigated retrospectively.Compared with the baseline scores, the visual field defect scores had significantly worsened by the end of the follow-up period (P0.0001, Wilcoxon paired signed rank test). The change in the visual field defect score (2.5+/-0.5) in eyes with average IOP levels ofor =16 mm Hg (n=36) was significantly greater (P=0.031, Mann-Whitney U test) than the change (1.3+/-0.3) in eyes with average IOP levels of16 mm Hg (n=64). Moreover, IOP ofor =18 mm Hg made a major contribution to the aggravation of visual field defects in eyes with POAG.Eyes with POAG and with mean IOP levels maintained ator =21 mm Hg underwent IOP-dependent progression of their visual field defects. Our results suggest that further IOP lowering would be beneficial in such cases.

This study investigated the effects of posterior sub-Tenon capsule (PST) injection of triamcinolone acetonide (TA) on intraocular pressure (IOP) in the human eye.The study included 115 patients who received PST injections of 40-mg TA to treat macular edema with diabetic retinopathy (n=57), branch retinal vein occlusion (n=35), central retinal vein occlusion (n=13), or other disorders (n=10). IOP measurements were performed on the day of injection, and 0.5, 1, 2, 3, 6, 9, and 12 months later.In 26 (22.6%) of the 115 eyes, an IOP of 24 mm Hg or higher was observed during the 12-month follow-up period after PST TA injection. IOP elevation significantly correlated with young age, but not with past history of diabetes mellitus or systemic hypertension, sex, or type of retinal disease with macular edema. In total, 23 eyes were treated with antiglaucoma medications to control elevated IOP (24 mm Hg or higher). External trabeculotomy was performed in 1 case where medications failed to correct elevated IOP.PST TA injection is associated with high rates of steroid-induced IOP elevation in eyes with previously normal IOP. However, IOP elevation may be less common after PST injection than after intravitreal injection. Our findings indicate that IOP must be carefully monitored after PST TA injection.

Purpose To investigate the effect of external trabeculotomy on eyes with steroid-induced glaucoma. Methods We retrospectively analyzed the surgical results of 14 eyes of seven patients that underwent trabeculotomy for the first surgical procedure. All patients had the history of receiving topical or systemic corticosteroids before the rise of intraocular pressure had been noted. Results After an average follow-up of 60.6 +/- 33.5 months, in all of the 14 eyes, intraocular pressure was well controlled below or equal to 21 mm Hg at the final examinations. Conclusions Surgical results of external trabeculotomy remain effective for a long time. It has been shown that the trabeculotomy can be a useful and effective surgical treatment of patients with steroid-induced glaucoma.