Outcomes of Primary Trabeculectomy in Secondary Glaucoma with Cytomegalovirus Anterior Uveitis

PRCIS: In eyes with CMV anterior uveitis-associated glaucoma, primary trabeculectomy with mitomycin C achieved a 92% success rate over a 4-year follow-up, providing sustained intraocular pressure control and reducing the frequency of uveitic attacks. PURPOSE: To evaluate long-term efficacy, safety, and complications of mitomycin C (MMC)-augmented trabeculectomy (TRAB) in eyes with cytomegalovirus anterior uveitis (CMV AU)-associated secondary glaucoma. METHODS: This retrospective study included 25 eyes of 25 patients with CMV-AU undergoing primary TRAB with MMC. Success was defined as IOP 5-21 mmHg without systemic acetazolamide or further surgery. Complete success required no topical medication, while qualified success allowed it. Kaplan-Meier survival analysis was used to evaluate success rates. RESULTS: Mean follow-up was 45.7±17.8 months. Preoperative IOP (36.0±9.0 mmHg) decreased significantly to 12.2±4.7 mmHg at the final visit (P<0.001); topical medications reduced from 3.7±0.5 to 0.7±1.1. Visual acuity was preserved (P>0.05). Postoperatively, uveitic episodes and antiviral use significantly decreased (P<0.001). Early hypotony occurred in 24% (n=6) of eyes. Late complications included bleb failure (24%) and hypotony (20%), mostly managed by needling or resuturing. Two eyes required secondary glaucoma surgery. At the final visit, complete success was achieved in 84% (n=21) and qualified success in 8% (n=2). The primary TRAB success rate was 92% but dropped to 60% when postoperative interventions (needling/resuturing) were treated as failures (P=0.007). CONCLUSIONS: Primary TRAB with MMC is a safe and effective strategy for CMV-AU associated glaucoma, reducing IOP and medication burden while preserving visual acuity. However, vigilance is required regarding early hypotony and the potential need for additional postoperative interventions.