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Nathan William Anderson Liles, Sophia Wang, Joshua D Stein, Paul Lichter; Thermal Sclerostomy Outcomes in a Retrospective Cohort. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4931.
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© ARVO (1962-2015); The Authors (2016-present)
Thermal sclerostomy was once the most widely used glaucoma filtering procedure. Although this surgery has been supplanted by other procedures, it may still have a role for patients who require aggressive intraocular pressure (IOP) lowering. We evaluate the short and long-term outcomes of thermal sclerostomy.
We identified 24 patients who underwent thermal sclerostomy between 1988 and 2003, at the Kellogg Eye Center. Demographic data, best-corrected visual acuity, IOP, complications, and number of glaucoma medications required were collected preoperatively and at postoperative day 1, 7, 30, 90, 365, and the last recorded visit or final visit documenting bleb failure. Blebs that were noted as no longer functioning or that required revision or additional incisional glaucoma surgery were recorded as having failed. Kaplan-Meier survival analysis was performed to evaluate bleb survival.
The median follow-up time after surgery was 11.9 years. The majority of the patients had primary open-angle glaucoma (50.0%) or normal-tension glaucoma (37.5%). There was a mean IOP reduction of 8.0 mmHg at 1 year of follow-up (p<0.05) and 5.0 mmHg (p<0.05) at the final visit from a mean pre-operative value of 16.8 mmHg. Fifteen patients (62.5%) at the final visit had a reduction of IOP by ≥20% from their preoperative value, and 11 (45.8%) had an IOP between 5 and 12 mmHg. At the final recorded visit, patients were using 1.4 fewer glaucoma agents (p<0.05). Additionally, 16 patients (66.7%) were using no glaucoma agents in the operated eye and only 1 patient (4.2%) was on ≥2 agents at the final visit. Mean pre-operative LogMar vision was 0.3 and dropped to 0.6 at the final visit. Early complications included hypotony maculopathy (n=1), choroidal detachment (n=9), corneal edema (n=3), and hyphema (n=1). Endophthalmitis occurred in 4 patients (16.7%) with a median onset of 6.3 years after surgery. Kaplan Meier survival probability for functioning blebs at 10 years was 0.79 (95% CI 0.54 - 0.90).
Patients undergoing thermal sclerostomy achieved a significant and sustained reduction in IOP and a reduction in the mean number of glaucoma agents used over 11.9 years of follow-up, with a high bleb survival rate of 79% at 10 years. This suggests that thermal sclerostomy may still be a valuable surgical option for patients requiring long-term bleb survival accompanied by aggressive IOP control.
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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