Long-term outcomes of primary trabeculectomy in diabetic patients with primary open angle glaucoma.

Objective: To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients with primary open angle glaucoma (POAG).

Methods: Patients with diabetes mellitus (DM) without retinopathy who had ≥6 months of postoperative follow-up were retrospectively compared with a control group selected from the pool of patients without DM matched case-by-case to the diabetic group by age, gender, race, preoperative intraocular pressure (IOP) and lens status. Surgical success was defined as IOP ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery.

Results: 41 eyes (29 patients) with DM and 81 eyes (64 patients) without DM were compared. Kaplan-Meier cumulative survival rates at 60 months were 57.8±9.3% (DM group) and 68.6±5.3% (control group), and the mean trabeculectomy survival times were 63 months (DM group, 95% CI 50.3 to 75.7) and 74.6 months (control group, 95% CI 67.1 to 82.1; p=0.095). Mean postoperative IOP of control group was statistically significant lower at 2-, 3-, 6- and 7-year follow-up visits (p<0.05). Rates of postoperative complications and additional glaucoma surgeries required were not different between the two groups.

Conclusions: POAG patients with DM without retinopathy undergoing primary trabeculectomy with MMC do not achieve the same long-term IOP control and may have a lower long-term surgical survival rate compared with patients without DM.