June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Antimetabolite Application Route During Trabeculectomy Increases Risk of Postoperative Ptosis
Author Affiliations & Notes
  • Joshua Lee Jones
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Andrew Gross
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Margaret L Pfeiffer
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
    Robert Cizik Eye Clinic, Houston, Texas, United States
  • Eric Crowell
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
    Robert Cizik Eye Clinic, Houston, Texas, United States
  • Nicholas P Bell
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
    Robert Cizik Eye Clinic, Houston, Texas, United States
  • Robert M Feldman
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
    Robert Cizik Eye Clinic, Houston, Texas, United States
  • Lauren S Blieden
    Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States
    Robert Cizik Eye Clinic, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   Joshua Jones, None; Andrew Gross, None; Margaret Pfeiffer, None; Eric Crowell, None; Nicholas Bell, None; Robert Feldman, None; Lauren Blieden, None
  • Footnotes
    Support  Hermann Eye Fund
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3836. doi:
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    • Get Citation

      Joshua Lee Jones, Andrew Gross, Margaret L Pfeiffer, Eric Crowell, Nicholas P Bell, Robert M Feldman, Lauren S Blieden; Antimetabolite Application Route During Trabeculectomy Increases Risk of Postoperative Ptosis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3836.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To report on the incidence of ptosis following trabeculectomy and identify risk factors for developing postoperative ptosis.

Methods : Charts of patients who underwent primary fornix-based trabeculectomy (trab) or combined phacoemulsification/trabeculectomy (phaco/trab) at the Cizik Eye Clinic between 1/1/2012 and 5/31/2015 were included. Patients with at least 12 months of follow-up were included, and those with previous eyelid surgery or ptosis documented prior to trab were excluded. If both eyes of a patient were eligible, the first eye that underwent surgery was selected. Patients were followed for a maximum of 4 years. Demographics, type of surgery (trab vs. phaco/trab), intraoperative technique (mitomycin-C [MMC] use, route of MMC by pledget or injection, and use of traction suture), use of prostaglandin drops pre- and post-trab, and postoperative data (i.e. presence of ptosis noted by glaucoma specialist, date of ptosis development, and follow-up duration) were recorded. Kaplan-Meier survival curve and stepwise Cox regression analysis were performed.

Results : 102 eyes of 102 patients met the eligibility criteria with a mean age of 66 years (±12, range 24-86) and 49 (48%) males. Of 100 patients who reported race/ethnicity, there were 45 (45%) White, 36 (36%) Black, 1 (1%) Hispanic, and 18 (18%) of other race/ethnicity. 61 (60%) eyes underwent trab and 41 (40%) eyes underwent phaco/trab. Only 3 eyes did not have MMC intraoperatively. MMC was applied by pledget in 66 (65%) eyes and by subconjunctival injection in 33 (32%) eyes. A corneal traction suture was used in 78 (76%) eyes, superior rectus bridle suture in 11 (11%) eyes, and no suture in 13 (13%) eyes. 94 (92%) eyes were on prostaglandin drops pre-trab compared to 9 (9%) post-trab. Mean follow-up duration was 32 months (±12, range 12-53).

44 (43%) eyes developed ptosis at a mean of 22 months (±1.5 standard error) after trab (Figure 1). Of these, 10 (23%) eyes were referred to the Oculoplastics service. Patients with MMC applied by pledget were 2.5 times more likely to develop ptosis than by subconjunctival injection (P=0.028).

Conclusions : The incidence of ptosis after trab is significantly higher in our series than the reported rate of 6.2-19%. MMC applied by pledget during surgery increases the risk of developing ptosis.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Kaplan-Meier Survival Curve

Kaplan-Meier Survival Curve

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