Study Finds Lower Trabeculectomy Success Rates in Hispanic Patients

Fresh evidence shows glaucoma surgery outcomes can hinge on more than just technique.

A new study in JAMA Ophthalmology suggests that trabeculectomy with mitomycin C (MMC) doesn’t play out equally across all patient groups. Participants of Hispanic descent experienced significantly lower success rates than those of European descent, reminding us that glaucoma surgery outcomes are not one-size-fits-all.

JAMA Ophthalmology announces study outcomes on its LinkedIn page.

Researchers at the Stein Eye Institute (University of California, Los Angeles, USA) conducted a matched cohort study of 222 eyes: 111 eyes from 96 Hispanic patients were matched with 111 eyes from 108 European-descent patients, all undergoing their first trabeculectomy with MMC.¹

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Key findings

Across every definition of surgical success, Hispanic patients fared worse. Five-year qualified success rates (with or without medications) were:¹

52% vs. 68% (criteria A: IOP ≤18 mm Hg)
45% vs. 61% (criteria B: IOP ≤15 mm Hg)
31% vs. 51% (criteria C: IOP ≤12 mm Hg)

Multivariable analyses confirmed that Hispanic descent carried a two- to three-fold higher risk of surgical failure, with hazard ratios between 2.07 and 3.03.¹

“These findings highlight the need for better strategies to regulate wound healing following trabeculectomy,” the authors wrote.¹

Complications and risk factors

Complications were more frequent in Hispanic patients (41.4%) than in European patients (26.1%). Early wound leaks appeared more common as well (12.6% vs. 5.9%), though the difference was not statistically significant.¹

Dr. Mark Gallardo shares outcomes of his four-site MIGS study.

Baseline disease severity mattered, too. Each one dB worse visual field mean deviation at baseline translated to a 2% to 3% increased risk of failure.¹

Clinical implications

The findings add weight to the argument that ethnicity should be factored into surgical planning. In an invited commentary, Dr. Thasarat Vajaranant and colleagues suggested that Hispanic patients show a higher tendency for postoperative scarring, possibly linked to shared biological traits with patients of African descent, such as fibroblast hyperreactivity.²

The commentary also noted that more than half of Hispanic patients were lost to follow-up after the first year. A statistic that may reflect broader social determinants of health, including access barriers, language differences, transportation challenges and healthcare literacy.²

Future directions

The authors acknowledged limitations, including the retrospective design and reliance on self-reported ethnicity. They call for prospective studies with larger, more diverse Hispanic subgroups, as well as integration of socioeconomic data.¹

With projections indicating that Hispanic individuals will become the largest U.S. subgroup affected by primary open-angle glaucoma by 2035, addressing these disparities is a clinical imperative.³ If trabeculectomy outcomes vary by ethnicity, the future of glaucoma care may need more tailoring than a one-size-fits-all surgical cut.

Editor’s Note: This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.

References

Besharati S, Mohammadzadeh V, Ashrafkhorasani M, et al. Outcomes of trabeculectomy with mitomycin C in patients of Hispanic vs European Descent. JAMA Ophthalmol. 2025 Aug 21:e252815. [Epub ahead of print.]
Vajaranant TS, Edward DP, Joslin CE. Glaucoma Surgery in Hispanic Individuals. JAMA Ophthalmol. 2025 Aug 21. [Epub ahead of print.]
Vajaranant TS, Wu S, Torres M, Varma R. The changing face of primary open-angle glaucoma in the United States: demographic and geographic changes from 2011 to 2050. Am J Ophthalmol. 2012;154(2):303-314.e3.