Clinical Ophthalmology (May 2021)
Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma
Abstract
Anca Pantalon,1 Crenguta Feraru,2 Filip Tarcoveanu,2,3 Dorin Chiselita1,2 1Ophthalmology Clinic, St. Spiridon Emergency University Hospital, Iași, Romania; 2Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania; 3Ophthalmology Department, Countess of Chester Hospital NHS Trust, Chester, UKCorrespondence: Anca PantalonOphthalmology Clinic, St. Spiridon University Hospital, Iași, RomaniaTel +40740686865Email [email protected] FeraruOphthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, RomaniaTel +40722752677Email [email protected]: The study assesed trabeculectomy survival in advanced open angle glaucoma (OAG).Methods: This is a retrospective longitudinal study in advanced OAG undergoing primary trabeculectomy. Clinical and demographic parameters were recorded. Surgical survival (qualified/complete) was calculated by Kaplan–Meier analysis for multiple upper limits of intraocular pressure (IOP) with/without medication (≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg, ≤ 12 mmHg); Cox hazard ratio analysis identified parameters influencing survival.Results: We included 165 eyes from 165 OAG patients: primary forms (POAG) – 86 eyes and secondary (pseudoexfoliative, SOAG) – 79 eyes; mean follow-up interval was 36.21 ± 13.49 months. Clinical parameters were comparable between sub-groups at baseline, except a higher IOP in SOAG vs POAG (36.6 ± 13.2 vs 32.7 ± 11.1 mmHg, p = 0.04); IOP reduction was similar (SOAG vs POAG) 53.93% vs 56.19%, p = 0.45, yet longer hospitalization (8.47 ± 4.39 (SOAG) vs 6.69 ± 3.01 days (POAG), p=0.03) and more medications (0.65 ± 0.24 vs 0.36 ± 0.16, p = 0.05) were needed to achieve comparable final IOP (16.0 ± 9.1 vs 15.1 ± 7.8 mmHg, p = 0.45). Kaplan Meier survival analysis applied for IOP ≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg and ≤ 12 mmHg, revealed complete success in 26.2%, 27.3%, 34.5% and 54.6% eyes, respectively; qualified success was found in 45.7%, 48.6%, 77% and 88.6% eyes, respectively. Multiple medications at baseline diminished survival in all tested models (hazard ratio HR > 1, p< 0.05), while 5FU+needling improved survival, mostly if combined with lower IOP regime: HR = 0.15, 95% CI = [0.07 − 1.12], p = 0.06, if IOP ≤ 15 mmHg and HR = 0.09, 95% CI = [0.02– 1.25], p = 0.06, if IOP ≤ 12 mmHg.Conclusion: Trabeculectomy in advanced OAG reached very good survival rates (77% and 88.6%) at 36 months postoperative, if IOP could be maintained ≤ 15 mmHg, respectively ≤ 12 mmHg with medication and additional needling+5FU maneuvers. Specific factors influencing survival were identified for each success definition.Keywords: trabeculectomy, long term success, advanced open angle glaucoma
