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Jose A. Paczka, Luz A Giorgi-Sandoval, Andrea Orozco-García; Long-term outcomes of trabeculectomy in contact lens wearers. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2944. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Contact lens wearing in patients in whom a filtering bleb is present after trabeculectomy imposes potential risks regarding IOP control and infection. The current aim of this report is to determine safety and efficacy of trabeculectomy in a cohort of patients wearing contact lenses on a long-term basis.
A retrospective review of complete medical records of patients who underwent trabeculectomy and kept wearing contact lenses after surgery for at least five years was done. Visual function (acuity and visual field), IOP control and bleb appearance were considered major outcome variables. Descriptive and comparative statistics were used, having a P value of 0.05 or less as a significant one.
Twenty three cases from 16 patients (6 males, 10 females; mean age of 59 ± 8.3 years) were included in the study. A miscellaneous group of glaucomas was present: Primary open-angle (65.2%), primary angle-closure (17.4%), steroid-induced (8.7%), Axenfeld-Rieger syndrome (4.3%) and traumatic (4.3%). Follow up after trabeculectomy was at least 5 years (9.3 ± 3.8) and time of contact lens wearing started no later than four months after surgery. Most eyes were supplemented with mitomycin C during trabeculectomy (86.9%), had moderate glaucoma damage (mean MD index, -8.12 ± 4.8 dB; mean vertical c/d ratio, 0.76 ± 0.22), high myopia (74.9%) and remained stable regarding visual acuity (86.9%). Mean pre-operative IOP (23.4 ± 5.3 mm Hg) was significantly higher (P = 0.001) as compared to the mean IOP of the last post-operative visit (15.4 ± 4.2 mm Hg). Bleb appearance was reported as aceptable or good (78.3%), avascular (17.4%) or encapsulated (4.3%). A few cases required cataract surgery (13%) or needling (17.4%). A target IOP was achieved in 82.6% of the cases, needing glaucoma medication in 7 cases. One case had a progression of visual field damage. No other siginificant complication was reported in the post-operative follow up period.
According to our findings contact lens wearing seems to be compatible with good outcomes after trabeculectomy in the long-term although a judicious behaviour has to be used to care for such patients due to potential hazards that can impact filtering integrity and function.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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