Nguyen AH, et al. - Experts compared the outcomes of initial trabeculectomy with mitomycin C in African descent (AD) patients with those of patients of European descent (ED) and identified the prognostic factors for failure. Findings suggested an association of African descent with higher failure rates and higher incidence of bleb leaks after initial trabeculectomy with mitomycin C vs European descent.

Methods

• In this retrospective matched cohort study, researchers matched 135 eyes of 105 AD patients with 135 eyes of 117 ED patients by age (within 5 years), surgeon, lens status, and follow-up time (within 1 year) from a single tertiary academic center.
• The interventions were initial trabeculectomy with mitomycin C.
• Qualified success rates were defined by criteria A, B, and C as final intraocular pressure of 18 mm Hg or less, 15 mm Hg or less, and 12 mm Hg or less, respectively, in addition to 20% or more, 25% or more, and 30% or more reduction of intraocular pressure or reduction of 2 or more medications.
• They compared the Kaplan-Meier survival curves log-rank test in AD and ED patients, and to estimate the influence of race/ethnicity on surgical success accounting for confounding variables they used Cox proportional hazard models.

Results

• Findings suggested that out of the 105 AD patients, 56 (53.3%) were female, and the mean (SD) age was 67.5 (10.4) years; of the 117 ED patients, 64 (54.7%) were female, and the mean (SD) age was 68.2 (10.0) years.
• Results demonstrated that for AD patients vs ED patients, the qualified success rates at 5 years for criteria A were 61% and 67%, respectively (difference, 7.3%; 95% CI, 4.4-10.4); for criteria B, 43% and 60% (difference, 17.6%; 95% CI, 15.2-20.0); and for criteria C, 25% and 40% (difference, 15.8%; 95% CI, 11.1-20.5).
• An association of AD with higher failure rate with criteria B and C for qualified success and with all criteria for complete success (ie, no need for medications) was seen on multivariable Cox regression analyses.
• In the AD group, the incidence of bleb leaks was higher (29 vs 11 eyes;P=.002).
• Furthermore, additional glaucoma surgeries were required by AD patients more often than ED patients (47 vs 26 eyes;P=.004).