Asian Journal of Research and Reports in Ophthalmology

Glaucoma is the most common irreversible blindness-causing pathology worldwide, and its prevalence continues to increase. It is often asymptomatic for a long time, which frequently delays diagnosis. Trabeculectomy remains the reference technique for surgical management of glaucoma.
The goal of this study is to describe the characteristics, outcomes, and postoperative complications of trabeculectomy, and to identify the risk factors related to its failure, in order to increase the success rate and its effectiveness in our context.

This is a retrospective study of eyes that underwent trabeculectomy between 2020 and 2024 at the ophthalmology department. Data were collected using a chart containing preoperative, perioperative, and postoperative parameters. An empirical analysis was conducted, leading to various statistical results. The SPSS software was used to study the prognostic factors for therapeutic failure of trabeculectomy.

A total of 62 eyes from 59 patients were identified. The most common etiology was primary open-angle glaucoma (50%). The average number of hypotensive medications used was 3.9, and 64% of patients were on quadruple therapy. The average visual acuity (VA) in logMAR before trabeculectomy was 1.55 (corresponding to 1.6/10), and the preoperative intraocular pressure (IOP) was an average of 30 mmHg ± 1.5. Regarding anti-metabolites, 40% had received 5-FU, while only 24% had received MMC.

Postoperatively, VA improved by two lines, from 0.4 log MAR immediately post-surgery to 0.2 log MAR at 10 months. At 10 months postoperative, the filtration bleb (BDF) was formed in 96% of cases, with two blebs remaining encapsulated, and one eye maintaining a flat bleb. The IOP reached an average of 14.8 ± 0.3 mmHg.

Early complications included immediate postoperative hypotony in 10 eyes, managed by reinforcement of the sutures, with recovery in 7 cases; 3 cases complicated with choroidal detachment and hyphema. Immediate postoperative elevated IOP was seen in 9 patients, managed by BDF massage in 5 eyes, and needling in 4, with recovery in follow-up visits.
Late complications were mostly cataract development in 16% of cases (10 eyes), choroidal detachment in 3 eyes (1 recovered, 2 progressed to phthisis), blebitis-related endophthalmitis in 2 eyes (recovered with antibiotic injections), and endophthalmitis from a corneal abscess on a severely altered surface, with no recovery.

Therapeutic success, defined as an IOP ≤18 mmHg, was achieved in 84% of cases (complete success in 44% of eyes, partial success with adjunctive medical treatment in 40% of eyes). Therapeutic failure occurred in 16% of cases. The risk factors associated with therapeutic failure identified in our study were: younger age (p=0.02), type of glaucoma (secondary glaucoma, p=0.04), preoperative IOP (p=0.001), and non-use of anti-metabolites (p=0.01).
Our results align with several studies in the literature, particularly the large AGIS study and the study by Edmunds et al., which represent national experience with trabeculectomy in England, focusing on complications and risk factors for failure.

This study is significant because it assesses how trabeculectomy treats glaucoma, determines risk factors for adult surgical failure, and demonstrates possible outcomes. By improving surgical methods, postoperative care, and patient selection, an understanding of these results raises long-term success rates and preserves vision. Knowledge of these risk factors will also help improve the success rate of trabeculectomy and minimize postoperative complications, leading to better overall management of glaucoma.