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Carole H Kim, Victoria L Tseng, Pablo Romero, Fei Yu, Joseph Caprioli, Harrison Quarry, Anne L Coleman; Risk of Surgical Failure in Patients with Hypotony after Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2945.
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© ARVO (1962-2015); The Authors (2016-present)
To compare risk of surgical failure in patients with or without hypotony after trabeculectomy
We identified glaucoma patients at the Stein Eye Institute who had a trabeculectomy between 1990 and 2014 with hypotony defined as intraocular pressures (IOP) of ≤5 mmHg on ≥2 consecutive visits at least six weeks after surgery. Controls included eyes without postoperative hypotony. Baseline characteristics that were examined included demographics, glaucoma type, presence of diabetes and hypertension, history of prior trabeculectomy, history of cataract surgery, family history of glaucoma, number of IOP-lowering medications, IOP, visual acuity (VA), number of sutures, laser suture lysis, and surgeon. Surgical failure was defined as (1) need for surgical bleb revision or additional glaucoma surgery or (2) loss of ≥2 lines of VA on ≥2 consecutive visits at least six weeks after surgery. Cox proportional hazard regression was performed to compare time between trabeculectomy and failure by each definition in eyes with or without hypotony, while adjusting for baseline factors. Logistic regression was performed to examine adjusted associations between baseline characteristics and hypotony.
We included 201 eyes with hypotony and 151 eyes without hypotony. The majority of patients were female (n=214, 60.8%), white (n=222, 66.1%), and diagnosed with primary open-angle glaucoma (n=187, 53.1%). Mean age was 66.9 ± 13.9 years and mean preoperative IOP was 19.5 ± 8.6 mmHg. There were no statistically significant associations between hypotony and time to failure by definition 1 (hazards ratio [HR]=1.04, 95% confidence interval [CI]=0.54-1.98) or definition 2 (HR=1.33, 95% CI=0.72-2.45). Baseline factors associated with postoperative hypotony included race (odds ratio [OR]=0.41, 95% CI=0.17, 0.99 for black vs. white; OR=0.41, 95% CI=0.17, 0.99 for other race vs. white), family history of glaucoma (OR=0.55, 95% CI=0.32-0.92), laser suture lysis (OR=0.45, 95% CI=0.27, 0.75), and surgeon (OR=3.48, 95% CI=1.69, 7.20 for surgeon 3 vs. surgeon 1).
This study suggests that patients with hypotony after trabeculectomy do not have increased risk of further surgical intervention or vision loss compared to patients without hypotony. Although numerical hypotony alone is often used as a criterion for surgical failure in studies of trabeculectomy outcomes, it often does not represent surgical failure in clinical practice.
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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