Probability of Filtration Surgery in Patients With Open-angle Glaucoma

Abstract

To investigate the probability of undergoing filtration surgery in either 1 or both eyes in patients in whom open-angle glaucoma was newly diagnosed. Methods and Design: A retrospective communitybased study of 295 residents of Olmsted County, Minnesota, in whom open-angle glaucoma was newly diagnosed between January 1, 1965, and December 31, 1980, was performed. Kaplan-Meier methods were used to estimate the cumulative probability of undergoing filtration surgery during a 20-year period. Results: At 20 years of follow-up, the Kaplan-Meier cumulative probability of undergoing filtration surgery in at least 1 eye was estimated to be 23% (95% confidence interval, 16%-30%), and in both eyes the estimate was 12% (95% confidence interval, 6%-17%). Patients with optic nerve damage at the time of diagnosis were more likely to undergo surgery than patients with elevated intraocular pressure but no damage (1 eye, 39% vs 15%; both eyes, 27% vs 5%). Conclusion: This retrospective study of a white population newly diagnosed as having and treated for openangle glaucoma indicates that while most patients did not undergo filtration surgery in the course of glaucoma therapy, at least one third of those with glaucomatous damage at the time of diagnosis underwent filtration surgery.

Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open‐Angle Glaucoma

“…Traditionally in the United States, filtration surgery has been used as the last resort to manage patients with OAG. Such surgery, although very efficacious in reducing glaucoma progression, is fraught with ocular complications and, thus, is reserved for patients with glaucoma who are losing their vision despite medications or less risky procedures, such as laser trabeculoplasty . Using filtration surgery as an end point has value because it has a high specificity for patients with progressive glaucoma.…”

“…Such surgery, although very efficacious in reducing glaucoma progression, is fraught with ocular complications and, thus, is reserved for patients with glaucoma who are losing their vision despite medications or less risky procedures, such as laser trabeculoplasty. [26][27][28] Using filtration surgery as an end point has value because it has a high specificity for patients with progressive glaucoma. However, the precise timing of glaucoma filtration surgery might vary by physician.…”

“…Treatment in the United States typically proceeds in a stepwise manner, starting with extensive use of topical ocular medications, followed by laser trabeculoplasty, and then filtration surgery as the last resort. All filtration surgeries are listed in Table . All filtration surgeries are listed in Table .…”

Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies

“…The probability of requiring a trabeculectomy during the long-term course of glaucoma is reported to be around 23% in primary open-angle glaucoma [20]. The efficacy of trabeculectomies varies among individuals and the long-term outcome of surgery cannot be accurately forecast.…”

A Call for Innovative Operations for Glaucoma

“…One recent retrospective series led to the estimate that almost one fourth of patients followed up for glaucoma for 20 years required filtering surgery. 15 Serious bleb-related morbidities anytime in the postoperative period are sobering reminders of the ongoing limitations of filtration surgery. However, we have in all likelihood reached a dead end in modifying filtering surgery in any profound way to increase effectiveness or minimize complications.…”