Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Abstract

Purpose To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome. Methods A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (o10 mm Hg), B (Z10 and o15 mm Hg), C (Z15 and o20 mm Hg), and D (Z20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome. Results The mean age was 62.5 ± 7.9 years and 41.21% (n ¼ 68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P ¼ 0.047, P ¼ 0.033, P ¼ 0.008, and Po0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP o15 mm Hg (Fisher's exact P ¼ 0.001) and o20 mm Hg (P ¼ 0.039) without medication.Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOPo15 mm Hg without medication and failure after surgery, respectively. Conclusions The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.

Quantification of the filtering bleb's structure with anterior segment optical coherence tomography

“…Our study confirmed that early postoperative IOP, that is, within 1 month, was also a useful predictor of IOP at 6 months, a finding that has been reported in earlier papers . Furthermore, IOP at 3 months was significantly associated with IOP at 6 months in the current study.…”

Efficacy and safety at 6 months of the XEN implant for the management of open angle glaucoma

“…The principal limitation of our study relies on the short follow-up period due to his recent market approval. The IOP at 6 months seems to be a good predictive factor for longer term surgical success of a surgery [20][21][22] but we have no long-term efficacy data for the XEN stent in our department. Regarding the complications, the long-term effect of subconjunctival of Mitomycin injection isn't known, a longer follow up might increase the number of conjunctival erosion and consequently endophthalmitis, as reported by Karri et al 23 .…”

First-in-human phase I study of ISTH0036, an antisense oligonucleotide selectively targeting transforming growth factor beta 2 (TGF-β2), in subjects with open-angle glaucoma undergoing glaucoma filtration surgery

“…While by the use of MMC alone such IOP ranges are rarely reached, achieving such IOP is highly desirable as this is indicative of long-term success of trabeculectomy. It heralds better clinical outcome for the patient, both in POAG and in closed-angle glaucoma [ 31 , 46 ],.…”