Does trabeculectomy work equally well in different types of glaucoma? A single-center, retrospective, comparative cohort study.

Introduction This study aimed to compare the efficacy of trabeculectomy (TE) in different glaucoma types.Methods A single-center retrospective analysis was conducted on eyes undergoing TE for primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), or angle-closure glaucoma (ACG) with a postoperative follow-up of 5 years. Parameters including intraocular pressure (IOP), number of IOP-lowering medications, mean defect (MD) of standard automated perimetry, mean peripapillary retinal nerve fiber layer (RNFL) thickness, and surgical success rates were analyzed and compared.Results After 5 years, mean IOP decreased significantly (P<0.01) in every group (POAG: 22.6±0.8mmHg to 12.1±1.0mmHg, PEX: 23.7±0.8mmHg to 14.0±1.8mmHg, ACG: 20.9±1.4mmHg to 13.3±0.8mmHg). The mean number of IOP-lowering medications also decreased significantly (P<0.01) in every group (POAG: 3.2±0.1 to 1.3±0.4, PEX: 3.3±0.1 to 1.0±0.3, ACG: 3.2±0.3 to 0.5±0.5). MD remained stable. RNFL thickness decreased significantly (P<0.05) during the first year (POAG: 61.0±1.6μm to 55.8±2.3μm, PEX: 63.7±2.0μm to 56.5±2.3μm, ACG: 62.2±3.9μm to 58.7±5.0μm). It then stabilized (P>0.05) starting from the first year until the fifth year (POAG: 53.0±6.1μm, PEX: 57.0±4.1μm, ACG: 58.8±5.6μm). Qualified (P=0.91) and complete (P=0.77) surgical success rates were similar among groups (POAG: 74% and 64%, PEX: 74% and 62%, ACG 71% and 58%).Conclusion TE demonstrated consistent efficacy in reducing IOP and the number of IOP-lowering medications, as well as achieving similar postoperative success rates, in eyes with POAG, PEX and ACG.