A twenty-year follow-up study of trabeculectomy: risk factors and outcomes

Ophthalmology. 2012 Apr;119(4):694-702. doi: 10.1016/j.ophtha.2011.09.043. Epub 2011 Dec 23.


Purpose: This study was undertaken to determine the performance of trabeculectomy surgery over a 20-year period and examine the associations between outcome and risk factors for trabeculectomy failure.

Design: Retrospective cohort study.

Participants: A total of 234 patients (330 procedures) who had undergone trabeculectomy surgery at Addenbrooke's Hospital, Cambridge, United Kingdom, between January 1988 and December 1990.

Methods: Patients were identified through surgical logbooks (n = 521 procedures on 380 patients); after this, a case-note review was undertaken, which identified 234 patients (330 procedures) who had available case notes.

Main outcome measures: Surgical success was defined as "complete success" while intraocular pressure (IOP) remained <21 mm Hg with no additional medication and as "qualified success" if those requiring additional topical medication were included. Functional success was defined if patients did not progress to legal blindness (visual acuity <3/60 or visual field <10 degrees).

Results: After 20 years, 57% were classified as complete success, 88% were classified as qualified success, and 15% had become blind. Those at risk of trabeculectomy failure were younger or had uveitic glaucoma. Those with pseudoexfoliation or aphakia were more likely to progress to blindness. Furthermore, those using 2 or more topical medications or with advanced visual field loss at the time of surgery were more at risk of both trabeculectomy failure and blindness.

Conclusions: This study indicates that trabeculectomy survival at 20 years may be approximately 60% with no topical medication and approximately 90% with additional topical medication. Patient age, preoperative topical medication use, glaucoma type, and glaucoma severity will independently influence this outcome. Trabeculectomy surgery is therefore a long-term solution to IOP control.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Glaucoma / physiopathology
  • Glaucoma / surgery*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Tonometry, Ocular
  • Trabeculectomy*
  • Treatment Failure
  • Treatment Outcome
  • Visual Acuity / physiology
  • Visual Fields / physiology
  • Young Adult


  • Antihypertensive Agents