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Rodrigo M Torres; Glaucoma surgery & ocular surface.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):450.
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© ARVO (1962-2015); The Authors (2016-present)
There are different types of glaucoma surgeries. Trabeculectomy is the most widely performed for open angle glaucoma and usually aqueous humor drainage implants are reserved for refractory glaucoma cases. Those techniques manipulate the conjunctival tissue and ocular surface anatomy is affected. Because of that, this work will review ocular surface disease (OSD) prevalence in patients with glaucoma surgical procedures.
A retrospective clinical study was performed, to review electronic clinical charts from patients operated by different types of glaucoma surgical procedures, who consulted to the OS service, since January 2006 to January 2017. The principal topics evaluated were: age, sex, previous topical treatment; glaucoma surgical technique performed and the final IOP. Regarding the OS, the evaluated topics were “Subjective” (patient discomfort) and “Objective”(tear meniscus, fluoresceine dye, break up time, lid position to detect ptosis and conjunctival anatomical characteristics.
Along eleven years, 296 patients (369 eyes operated), 171 men and 125 women, consulted to the OS service because OS discomfort after glaucoma surgery. Surgical procedures: Trabeculectomy: 322 eyes; Ahmed implant: 37 eyes; Bearveldt implant: 8 eyes and Molteno implant: 2 eyes. All of them have history of maximun topical treatment for glaucoma (3 or more drops by day) and history about OS problems previous to the glaucoma surgery. Moreover, their symptoms worsed after surgery. From the total of cases, 15 don't need to add glaucoma drops treatment after surgery. Ptosis was detected in 292 eyes. Conjuntival tissue was altered in the operated eye, (with al least on of the follow): big blebs: 86, avascular blebs: 292:, thin blebs: 179, multi-chistic blebs: 45, tube extrusion: 7, bleb rupture: 13.
OS problems were frequent after glaucoma surgery, as this work has showed. But, all of the cases have history about previous glaucoma topical treatment and OS complaint. Could new glaucoma surgical techniques and technologies improve IOP control and avoid OS complications? The medical industry understand that is possible, and different new surgical device and procedures for glaucoma (as ExPRESS, iStent or iMvalv and more...) are developing. But time and studies with these devices will be necessary to confirm their possible success and advantage.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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