Pre-operative intraocular pressure does not influence outcome of trabeculectomy surgery: a retrospective cohort study

Abstract

BackgroundTo investigate whether pre-operative intraocular pressure (IOP) predicts outcome of trabeculectomy surgery in patients with primary open angle glaucoma over a 3-year period of follow-up.MethodsRetrospective cohort study, of a total of 61 patients (80 procedures) who had undergone trabeculectomy surgery after failed medical management at a single centre between 2000 and 2011. Patients were identified through surgical logbooks. A subsequent case note-review identified 61 patients (80 procedures) with primary open angle glaucoma (POAG). The primary outcome was success of trabeculectomy surgery, with failure defined as intraocular pressure (IOP) > 21 mmHg, ≤ 5 mmHg or not reduced by 20% at two consecutive follow-up visits 3-months post-operatively. Qualified success was defined as surgical success with the use of supplemental medical therapy. Secondary outcomes included visual acuity, Humphrey visual field MD, surgical complications and post-operative interventions.ResultsAt 3 years, the odds ratio of failure was 0.93 per mmHg pre-operative IOP (95% C.I. 0.83-1.03, p = 0.15 Wald Χ2 test), and the odds ratio of failure or qualified success was 0.96 (95% C.I. 0.89-1.04, p = 0.35). The incidence of surgical complications showed an odds ratio of 1.02 per mmHg pre-operative IOP (95% C.I. 0.95-1.10, p = 0.55 Wald Χ2 test). The incidence of post-operative interventions showed an odds ratio of 1.01 per mmHg pre-operative IOP (95% C.I. 0.94-1.09, p = 0.80 Wald Χ2 test).ConclusionsPre-operative IOP does not predict success of trabeculectomy surgery in POAG patients during the first 3 years of follow-up. The incidence of surgical complications and post-operative interventions shows no association with pre-operative IOP.

Augmented trabeculectomy-outcomes of first hundred versus second hundred surgeries of a fellowship-trained glaucoma surgeon

“…This is consistent with the findings of a study on POAG patients where they found that preoperative IOP did not predict the success of trabeculectomy or the incidence of surgical complications and low preoperative IOP did not increase the need for postoperative interventions. 15 However Jampel et al 16 found lower preoperative IOP to be associated with trabeculectomy failure. We found no difference between the two groups with regards to the percentage of patients achieving complete and partial success as demonstrated in the Kaplan-Meier curves.…”

The influence of selective laser trabeculoplasty on the success of trabeculectomy

“…There may be some factors which can influence the final success of trabeculectomy. [ 8 9 ] The main factor may be the inflammatory response of the eye to the surgery, which may be influenced by surgical trauma and/or previous medication or previous inflammation. While Ayala et al .…”

Glaucoma-inducing Procedure in an <em>In Vivo </em>Rat Model and Whole-mount Retina Preparation

“…Laser trabeculoplasty is used to increase the outflow of aqueous humor 19 . Another surgical therapy, called trabeculectomy, creates an alternative drainage site to filter AH when the traditional trabecular pathway is blocked [20][21] . These treatment options have been known to effectively reduce IOP.…”