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Usiwoma Abugo, Leslie Stiff Jones, John Kwagyan; The Influence of Diabetes on Glaucoma Surgical Outcomes in the Minority Population. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2661.
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To identify the role diabetes plays in the success of a primary glaucoma surgical intervention and the incidence of surgical complications in a predominately African American metropolitan hospital clinic population.
A retrospective chart review was conducted at Howard University Hospital from 1/1/2004-4/3/2014. Inclusion criteria were age >18, and documented diagnosis of glaucoma or ocular hypertension by optic nerve appearance and visual field loss. Patients <18 or with secondary interventions were excluded. Variables included diabetes and/or hypertension, type of diabetes, HbA1C level, blood sugar, body mass index(BMI), blood pressure pre-op, pre and post-op mean ocular perfusion pressure(MOPP), pre and post-op IOP, and complications. The outcomes were analyzed with SPSS software using various methods with failure of a primary invasive glaucoma intervention being defined as post-op IOP being greater than 17 mmHg at the last documented visit.
A total of 93 patients (59 F, 34 M, average age 66.5±12.9) were included. The participants were Black(88), Hispanic(3), and Indian(2). The majority of the patients had primary open angle glaucoma (53.8%), neovascular glaucoma (11.9%) and chronic angle closure (9.7%). The interventions were aqueous tube shunt placement (41), combined procedures (27), Trabeculectomy with Mitomycin C (12), EX-PRESS glaucoma filtration device insertion (12), and Trabectome (1). 49.5% of the patients did not have diabetes vs 50.5% with diabetes. Having a diagnosis of diabetes did not correlate to failure of surgery (p<.871). When comparing diabetics to non diabetics, diabetics had a greater percentage of complications (53.7% vs 46.3%;p<.462). For Trabeculectomies, diabetics had a significantly higher rate of complications (p<.017). The post-operative MOPP approached significance (p<.071). The BMI pre-operatively was statistically significant (p<.004). For the patients with HbA1c data available it was seen that a higher HbA1c was related to more complications (57% vs 42;p<.857).
No significant difference was seen in success rates for diabetics vs non diabetics. Diabetics had a higher rate of complications after glaucoma surgery. Having an elevated BMI in our study significantly increased complications. Our study shows the importance of tight blood sugar control and weight management in the clinical management of any patient undergoing invasive glaucoma surgery.
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