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• W2129644490 abstract "Fontana et al presented the 3-year outcomes of a retrospective cohort of low-risk primary trabeculectomy augmented with mitomycin C.1Fontana H. Nouri-Mahdavi K. Lumba J. et al.Trabeculectomy with mitomycin C Outcomes and risk factors for failure in phakic open-angle glaucoma.Ophthalmology. 2006; 113: 930-936Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar We commend them for the design and their use of the stratified outcomes criteria for the evaluation and presentation of their results.We would like further clarification, however, regarding the noticeable absence of any mention of the use of postoperative 5-fluorouracil subconjunctival injections, especially after such a high rate of suture lysis, clearly indicating that these cases were heading for possible failure. A recently published systematic review of the use of postoperative 5-fluorouracil shows a reduction in the failure rate in both high-risk and primary trabeculectomy cases relative to controls.2Wormald R. Wilkins M.R. Bunce C. Post-operative 5-fluorouracil for glaucoma surgery.Cochrane Database Syst Rev. 2001; (CD001132)Google Scholar For the patients who required a low final intraocular pressure (IOP) (criterion C), we believe the use of postoperative 5-fluorouracil injections would be justified.The authors concluded that “suture lysis after trabeculectomy and prior ALT [argon laser trabeculoplasty] are associated with a higher risk of failure when low IOPs are required.” We think that this conclusion should be interpreted with caution because the study methodology is not robust enough to support such a conclusion. This, we believe, is supported by the fact that the study cohort had a low number of patients who had prior ALT to start with (13%), and the authors’ conclusion, as they admitted, conflicts with the Advanced Glaucoma Interventional Study’s result.3AGIS InvestigatorsThe Advanced Glaucoma Interventional Study (AGIS): 11. Risk factors for failure for trabeculectomy and argon laser trabeculoplasty.Am J Ophthalmol. 2002; 134: 481-498Abstract Full Text Full Text PDF PubMed Scopus (172) Google ScholarEven though there was a statistical association, the authors failed to give a biologically plausible explanation for it. The application of the Cox proportional hazard model to assess potential causes of failure using the stratified outcomes criteria as primary end points could by chance result in statistical significance for some risk factors. Also, the authors did not state whether or not they adjusted for potential confounders such as ethnicity, glaucoma type, conjunctival flap position, duration of mitomycin C exposure, and preoperative IOP.Even though the authors were careful in stating that “suture lysis after trabeculectomy and prior ALT are associated [our emphasis] with a higher risk of failure when low IOPs are required,” we believe that this conclusion is potentially misleading, especially to busy ophthalmologists who may read the abstract but not the entire article. Fontana et al presented the 3-year outcomes of a retrospective cohort of low-risk primary trabeculectomy augmented with mitomycin C.1Fontana H. Nouri-Mahdavi K. Lumba J. et al.Trabeculectomy with mitomycin C Outcomes and risk factors for failure in phakic open-angle glaucoma.Ophthalmology. 2006; 113: 930-936Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar We commend them for the design and their use of the stratified outcomes criteria for the evaluation and presentation of their results. We would like further clarification, however, regarding the noticeable absence of any mention of the use of postoperative 5-fluorouracil subconjunctival injections, especially after such a high rate of suture lysis, clearly indicating that these cases were heading for possible failure. A recently published systematic review of the use of postoperative 5-fluorouracil shows a reduction in the failure rate in both high-risk and primary trabeculectomy cases relative to controls.2Wormald R. Wilkins M.R. Bunce C. Post-operative 5-fluorouracil for glaucoma surgery.Cochrane Database Syst Rev. 2001; (CD001132)Google Scholar For the patients who required a low final intraocular pressure (IOP) (criterion C), we believe the use of postoperative 5-fluorouracil injections would be justified. The authors concluded that “suture lysis after trabeculectomy and prior ALT [argon laser trabeculoplasty] are associated with a higher risk of failure when low IOPs are required.” We think that this conclusion should be interpreted with caution because the study methodology is not robust enough to support such a conclusion. This, we believe, is supported by the fact that the study cohort had a low number of patients who had prior ALT to start with (13%), and the authors’ conclusion, as they admitted, conflicts with the Advanced Glaucoma Interventional Study’s result.3AGIS InvestigatorsThe Advanced Glaucoma Interventional Study (AGIS): 11. Risk factors for failure for trabeculectomy and argon laser trabeculoplasty.Am J Ophthalmol. 2002; 134: 481-498Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar Even though there was a statistical association, the authors failed to give a biologically plausible explanation for it. The application of the Cox proportional hazard model to assess potential causes of failure using the stratified outcomes criteria as primary end points could by chance result in statistical significance for some risk factors. Also, the authors did not state whether or not they adjusted for potential confounders such as ethnicity, glaucoma type, conjunctival flap position, duration of mitomycin C exposure, and preoperative IOP. Even though the authors were careful in stating that “suture lysis after trabeculectomy and prior ALT are associated [our emphasis] with a higher risk of failure when low IOPs are required,” we believe that this conclusion is potentially misleading, especially to busy ophthalmologists who may read the abstract but not the entire article. Author replyOphthalmologyVol. 114Issue 6PreviewWe read with interest the letter by Jones et al regarding our retrospective study of a cohort of patients undergoing trabeculectomy with mitomycin C. They raised three issues: Full-Text PDF" @default.
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• W2129644490 date "2007-06-01" @default.
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• W2129644490 title "Trabeculectomy with Mitomycin C" @default.
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• W2129644490 doi "https://doi.org/10.1016/j.ophtha.2007.03.004" @default.
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