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Risk Factors for Hyphema After Trabeculectomy With Mitomycin C

Kojima, Sachi MD*; Inatani, Masaru MD, PhD*,†; Shobayashi, Kohei MD*; Haga, Akira MD*; Inoue, Toshihiro MD, PhD*; Tanihara, Hidenobu MD, PhD*

doi: 10.1097/IJG.0b013e3182741c85
Original Studies

Purpose: To determine the risk factors for hyphema after trabeculectomy with mitomycin C (MMC).

Patients and Methods: In total, 420 patients (420 eyes) with glaucoma who underwent trabeculectomy with MMC between June 1, 2005 and December 31, 2010 at Kumamoto University Hospital, Japan, were retrospectively evaluated. Hyphema after trabeculectomy was defined as the niveau formed by bleeding in the anterior chamber. Logistic multivariable analysis was applied to determine the risk factors for hyphema.

Results: Of the 420 patients, 104 (24.8%) had hyphema. Neovascular glaucoma [NVG; odds ratio (OR)=2.404; P=0.0017] and anticoagulant or antiplatelet medication at trabeculectomy (OR=2.143; P=0.0274) were significant risk factors for hyphema. Of the 108 NVG patients, 43 (39.8%) had hyphema after trabeculectomy with MMC. In the subgroup analysis of NVG patients, neovascularization in the anterior chamber angle at trabeculectomy (OR=5.7886; P=0.0163) and anticoagulant or antiplatelet medication at trabeculectomy (OR=3.3325; P=0.0450) were risk factors for hyphema, whereas preoperative intravitreal bevacizumab injection significantly reduced the hyphema risk (OR=0.3568; P=0.0275).

Conclusions: The risk factors for hyphema after trabeculectomy with MMC are independently associated with NVG and anticoagulant or antiplatelet medication. Neovascularization in the anterior chamber at trabeculectomy and anticoagulant or antiplatelet medication enhance the risk of hyphema developing in NVG patients, whereas preoperative injection of intravitreal bevacizumab reduces the likelihood.

*Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto

Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan

M.I, T.I, H.T: design and conduct of the study; S.K, K.S, A.H: collection and management of the data; S.K, K.S, A.H, T.I: analysis; S.K., M.I., K.S., A.H., T.I., H.T.: interpretation of the data; S.K, M.I, H.T: preparation of the first draft of the manuscript; S.K., M.I., K.S., A.H., T.I., H.T.: review and approval of the manuscript. All procedures conformed to the Declaration of Helsinki, and informed consent for surgical treatments was obtained from all of the patients. The Institutional Review Board of Kumamoto University Hospital, Kumamoto City, Japan, approved the retrospective study protocol.

Supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (MEXT), Tokyo, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Masaru Inatani, MD, PhD, Department of Ophthalmology, Faculty of Medical Science, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui 910-1193, Japan (e-mail: inatani@u-fukui.ac.jp).

Received February 26, 2012

Accepted September 11, 2012

© 2014 by Lippincott Williams & Wilkins.