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Jonathan Young, Ross Passo, Beth Edmunds, John C Morrison, Hana Takusagawa, Shandiz Tehrani; The Effect of Smoking on Trabeculectomy Outcomes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):490.
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Trabeculectomy surgery is a mainstay for lowering intraocular pressure (IOP) in glaucoma patients. Surgical failure in controlling IOP is often related to post-surgical inflammation and scarring. Cigarette smoke is a known ocular irritant, and exposure to cigarette smoke may increase the risk for trabeculectomy failure. This study retrospectively examined trabeculectomy outcomes in adult subjects with and without a smoking history at a single academic institution.
We performed a retrospective chart review of subjects who underwent primary trabeculectomy for glaucoma, without prior intraocular surgery, and with a minimum follow up of one month from 05/2007 to 03/2017 at the Casey Eye Institute. We analyzed the outcomes of 3 groups: (1) everyday smokers, (2) former smokers, and (3) never smokers. Exclusion criteria included the diagnosis of uveitic, congenital, or neovascular glaucoma, and age < 18 years. Smoking status, age at time of surgery, sex, race, mean IOP, number of IOP lowering medications, and need for additional glaucoma surgery post-trabeculectomy were compared.
We identified 77 subjects with a known current smoking history, and 77 age, sex, and race matched control subjects with a former smoking history, and no smoking history. The 3 groups were similar in their preoperative IOP and glaucoma type. There were significant differences between groups in mean IOP during post-operative intervals of 45-270 days, 270-635 days, and beyond 1000 days (p<0.05 kruskal-wallis one-way ANOVA). In general, the trend toward higher IOP post trabeculectomy in the smoking group was noted in multiple follow up interval periods. Survival curves and mean IOP lowering medications were not significantly different between the three groups. A greater number of secondary glaucoma procedures (bleb revision, repeat trabeculectomy, tube implant, and cyclophotocoagulation) were performed in former smokers and current smokers, than lifetime non-smokers.
Current smoking history at the time of trabeculectomy was associated with higher IOP post trabeculectomy. This difference did not result in statistically significant differences in trabeculectomy survival. Former and current smoking was associated with a higher incidence of secondary glaucoma procedures post trabeculectomy. Thus, trabeculectomy failure in current and former smokers may be more severe and require additional surgical intervention relative to lifetime non-smokers.
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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