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Achini Makuloluwa, Sohraab Yadav, Anshoo Choudhary; Viscocanalostomy for patients at high risk of glaucoma filtration surgery failure. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6513.
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© ARVO (1962-2015); The Authors (2016-present)
Intra-ocular pressure (IOP) management can be challenging in patients with characteristics that pose a high risk of filtration surgery failure. Typically these patients are managed using aqueous shunt devices or augmented trabeculectomy. Viscocanalostomy offers a safe bleb-independent option. We performed a consecutive prospective study to assess outcomes of viscocanalostomy in eyes at high risk of filtration failure.
All patients with inadequate IOP control and high risk characteristics who underwent viscocanalostomy in the same eye between 2010 and 2015 were included. Surgery was performed without antimetabolites or intra-scleral implants. Outcomes included post-operative IOP reduction, number of topical medications used and Kaplan-Meier survival analysis for qualified and complete surgical success.
100 patients with a mean age of 67.5 years met the inclusion criteria. All had long-term glaucoma medication use. High risk characteristics included failed trabeculectomy (23%), vitreoretinal surgery (17%), corneal graft, neovascular glaucoma, uveitis and pseudophakia. 46% of the patients had two or more risk factors. Pre-operative IOP reduced significantly from 26.7±7.8mmHg (mean±SD) to 15.7±5.3 at 1 month, 14.6±4.0mmHg at 3 months, 14.6±3.3mmHg at 6 months, 15.3±4.1mmHg at 12 months, 15.8±4.7mmHg at 24 months, 15.4±4.4mmHg at 36 months and 17.3±4.2mmHg at 48 months (p<0.01). The mean number of topical glaucoma medication was reduced from 3.5 pre-operatively to 0.7 at final follow-up. Qualified surgical success (IOP≤21mmHg with or without topical medication) was achieved in 93% of the patients at final follow-up. Complete surgical success (IOP≤21mmHg without topical medication) was achieved in 61% of the patients at final follow-up. There were no early or late complications.
These results are consistent with our hypothesis that viscocanalostomy is a safe and effective surgical option for patients who are at high risk of filtration failure.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure: Kaplan-Meier survival curves representing the complete (blue) and qualified (green) surgical success.
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