Otago Glaucoma Surgery Outcome Study: long-term results of 841 trabeculectomies

To describe the long-term outcomes of trabeculectomies performed at Dunedin Hospital and followed in the Otago Glaucoma Surgery Outcome Study. Prospective non-comparative case series of 841 eyes of 607 patients who had first trabeculectomies for primary open- or closed-angle glaucoma at Dunedin Hospital between 1976 and 2005 and followed for a mean of 7.5 years (standard deviation 6.0). The probability of a trabeculectomy controlling the intraocular pressure at 21 mmHg or less at 1, 10 and 20 years was 0.96 (95% confidence interval [CI] 0.95, 0.97), 0.86 (95% CI 0.83, 0.89) and 0.79 (95% CI 0.74, 0.83), respectively. Visual acuity was maintained or improved between preoperative assessment and final follow up in 68% of cases. The probability of not being blind following trabeculectomy at 1, 10 and 20 years was 0.98 (95% CI 0.96, 0.98), 0.83 (95% CI 0.80, 0.87) and 0.70 (95% CI 0.64, 0.76), respectively. The proportion of those with glaucomatous field loss increased during follow up from 16% (44/283) at 0-5 years to 50% (10/20) for those with 21 or more years of follow up. A repeat drainage procedure was required in 65 eyes (8%) (56 Molteno implant insertions and 9 repeat trabeculectomies). Intraocular pressure was well controlled by trabeculectomy; however, a steady decline in intraocular pressure control, visual acuity and visual field occurred during follow up.