To evaluate the outcomes of trabeculectomy performed on eyes with medically uncontrolled acute angle closure glaucoma (AACG).

The authors reviewed 31 eyes of 30 acute primary angle-closure glaucoma patients who had undergone trabeculectomy. The eyes were divided into two groups: eyes which did not respond to medical and/or laser treatment (Group A, 16 eyes) and those which initially responded to medical and/or laser treatment and later had an intraocular pressure (IOP) increase (Group B, 15 eyes). Complete success was defined as a final IOP below 21 mmHg without medication, and qualified success was defined as a final IOP below 21 mmHg with medication. Patients whose postoperative IOP was 22 mmHg or greater on at least two serial measurements or who required additional glaucoma surgery were classified as failures.

The mean follow-up was 43.1±32.3 months. The five-year qualified success rate was 56.3% in Group A and 100% in Group B (log-rank test, p =0.02). The preoperative IOP was significantly higher in Group A (38.0±11.5 mmHg) than in Group B (21.8±12.2 mmHg) ( p <0.01). Factors found not to be significant included age, gender, peripheral anterior synechiae, a glaucomatous optic disc, and visual field damage. The postoperative complications were similar between the two groups ( p >0.05).

The medically uncontrolled AACG appears to have an adverse effect on the outcome of trabeculectomy. Success of trabeculectomy in AACG seems to be inversely related with elevated preoperative intraocular pressure.