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

Nesaratnam N, Sarkies N, Martin KR, Shahid H - BMC Ophthalmol (2015)

Bottom Line: 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.The incidence of surgical complications and post-operative interventions shows no association with pre-operative IOP.

View Article: PubMed Central - PubMed

Affiliation: School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK. nn252@cam.ac.uk.

ABSTRACT

Background: To 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.

Methods: Retrospective 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.

Results: At 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 Χ (2) 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 Χ (2) 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 Χ (2) test).

Conclusions: Pre-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.

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Forest plot of early and late post-operative complications. Early complications occurred within 1 month of trabeculectomy surgery, and late complications occurred after this time. Data are presented with 95% confidence intervals. (* = p < 0.05, ** = p < 0.001 according to Wald Χ2 test).
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Fig6: Forest plot of early and late post-operative complications. Early complications occurred within 1 month of trabeculectomy surgery, and late complications occurred after this time. Data are presented with 95% confidence intervals. (* = p < 0.05, ** = p < 0.001 according to Wald Χ2 test).

Mentions: Post-operative complications experienced by the study patients are listed in Table 3. A total of 47 complications in 38 eyes (48%) were reported. Early complications, occurring within the first post-operative month, included hypotony, bleb encystment, flat anterior chamber, vitreous haemorrhage and bleb leak. Late complications, occurring after this time, included cataract formation, hypotony, bleb encystment and bleb leak. The odds ratios for each complication are illustrated using a Forest plot in Figure 6. The odds ratio of having at least one surgical complication was 1.02 per mmHg pre-operative IOP (95% C.I. 0.95-1.10, p = 0.55 Wald Χ2 test). There was a statistically significant odds ratio for cataract formation of 1.09 per mmHg pre-operative IOP (95% C.I. 1.00-1.18, p = 0.04 Wald Χ2 test), and thus increased risk of cataract with a higher pre-operative baseline IOP. No other post-operative complication was significantly affected by pre-operative IOP.Table 3


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

Nesaratnam N, Sarkies N, Martin KR, Shahid H - BMC Ophthalmol (2015)

Forest plot of early and late post-operative complications. Early complications occurred within 1 month of trabeculectomy surgery, and late complications occurred after this time. Data are presented with 95% confidence intervals. (* = p < 0.05, ** = p < 0.001 according to Wald Χ2 test).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352261&req=5

Fig6: Forest plot of early and late post-operative complications. Early complications occurred within 1 month of trabeculectomy surgery, and late complications occurred after this time. Data are presented with 95% confidence intervals. (* = p < 0.05, ** = p < 0.001 according to Wald Χ2 test).
Mentions: Post-operative complications experienced by the study patients are listed in Table 3. A total of 47 complications in 38 eyes (48%) were reported. Early complications, occurring within the first post-operative month, included hypotony, bleb encystment, flat anterior chamber, vitreous haemorrhage and bleb leak. Late complications, occurring after this time, included cataract formation, hypotony, bleb encystment and bleb leak. The odds ratios for each complication are illustrated using a Forest plot in Figure 6. The odds ratio of having at least one surgical complication was 1.02 per mmHg pre-operative IOP (95% C.I. 0.95-1.10, p = 0.55 Wald Χ2 test). There was a statistically significant odds ratio for cataract formation of 1.09 per mmHg pre-operative IOP (95% C.I. 1.00-1.18, p = 0.04 Wald Χ2 test), and thus increased risk of cataract with a higher pre-operative baseline IOP. No other post-operative complication was significantly affected by pre-operative IOP.Table 3

Bottom Line: 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.The incidence of surgical complications and post-operative interventions shows no association with pre-operative IOP.

View Article: PubMed Central - PubMed

Affiliation: School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK. nn252@cam.ac.uk.

ABSTRACT

Background: To 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.

Methods: Retrospective 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.

Results: At 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 Χ (2) 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 Χ (2) 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 Χ (2) test).

Conclusions: Pre-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.

Show MeSH
Related in: MedlinePlus