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Michael Abendroth, George Papachristou, Erik Lehman, Christine Callahan; Treatment Outcomes and Post-Operative Complications of Trabeculectomy and Glaucoma Drainage Device Surgery by Age. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4954.
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Prior studies have compared the treatment outcomes and post-operative complications of trabeculectomy and glaucoma drainage device surgery, but to our knowledge, none have stratified these comparisons by patient age. Our study compares the outcomes and complications of trabeculectomy and glaucoma drainage device surgery by age.
This was a retrospective, consecutive case series of 142 eyes (123 patients) that had uncontrolled glaucoma on maximum tolerated medical therapy that underwent trabeculectomy with mitomycin C or glaucoma drainage device surgery. Primary outcome measures were IOP, treatment failure (IOP >21 mmHg or reduced by <20% on two consecutive follow-up visits, IOP ≤5 mmHg on two consecutive follow-up visits, reoperation for glaucoma, or loss of light perception vision), and post-operative complications, defined as non-serious (e.g. corneal edema) or serious (e.g. choroidal hemorrhage). Results were stratified into age groups of <60, 60-69, 70-79, and ≥80 and then compared using the Wilcoxen signed-rank test and Chi-square test.
At one year, the median percent decrease from pre-operative IOP in the trabeculectomy and glaucoma drainage device groups was 39% vs. 56% overall (P<.001), 44% vs. 53% in the <60 age group (P=.591), 33% vs. 48% in the 60-69 age group (P=.114), 39% vs. 62% in the 70-79 age group (P<.001), and 38% vs. 57% in the ≥80 age group (P=.224), respectively. The probability of failure was 32% vs. 35% overall (P=.738), 25% vs. 49% in the <60 group (P=.269), 57% vs. 21% in the 60-69 group (P=.035), 14% vs. 26% in the 70-79 group (P=.462), and 25% vs. 40% in the ≥80 group (P=.638), respectively. The probability of non-serious complication was 43% vs. 45% overall (P=.730), 30% vs. 44% in the <60 group (P=.499), 48% vs. 39% in the 60-69 group (P=.468), 39% vs. 51% in the 70-79 group (P=.305), and 50% vs. 50% in the ≥80 group (P=1.000), respectively. The probability of serious complication was 37% vs. 39% overall (P=.819), 70% vs. 35% in the <60 group (P=.075), 35% vs. 22% in the 60-69 group (P=.268), 27% vs. 56% in the 70-79 group (P=.019), and 38% vs. 50% in the ≥80 group (P=.444), respectively.
Glaucoma drainage device surgery was more effective than trabeculectomy overall and for each age group. There were no significant differences in the probabilities of failure or non-serious or serious complications for any age group.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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