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Nadia Rios Acosta, Lisa Gould, Jennifer Rahman, Gdih Gdih, Shveta Bali; Effect of Tobacco Smoking on Outcomes of Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):491.
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Despite tobacco smoking being a risk factor for inflammatory disorders, uveitis and ocular surface disease, little is known about its effect on outcomes after trabeculectomy. The purpose of this retrospective chart review study was to compare the outcomes in smokers versus nonsmokers after trabeculectomy.
Charts from 2007 to 2015 from one surgeon were screened for documented history of smoking status prior to surgery. Patients who quit smoking any time before or during the post-operative period were excluded. Pre-operative parameters included age, diagnosis, pre-surgery intraocular pressure (IOP), length of diagnosis of glaucoma and number of ocular hypotensive medications. Bleb related interventions e.g. 5-flourouracil injections, laser suture lysis, or bleb revision performed during the post-operative period were noted. Success was defined as IOP <21 mm Hg and 20% IOP reduction from pre-operative baseline without (complete success) or with (qualified success) ocular hypotensive medications. Failure was identified as violation of the criteria mentioned above. Twenty-five eyes (18 patients) were included in the study group and 71 eyes (60 patients) were included in the control group. A mixed effects logistics regression model was used to account for repeated measures within subjects.
A total of 96 eyes were studied, the mean age was 71.6+ 10.9 years and 53.8% were females. Pre-surgery IOP was found to be significantly higher in the smoking group (p = 0.043). At one-year follow-up, odds of post-operative interventions or failure were higher in the smoking group as compared to controls (Odds ratio: 3.816, 95% CI: 1.2-11.7, p =0.022). One-year trabeculectomy success rate was 80% in the smoking group and 97.2% in the non-smoking group (p=0.012). In absence of bleb related interventions, the success rates of trabeculectomy were 56% for the smoker group and 83.1% in the control group respectively at follow-up of one year (Odds ratio: 3.816, 95% CI: 1.2-11.7, p =0.022). A second model including baseline IOP as a covariate alongside smoking didn’t show a change in the estimates for effects of smoking, thereby ruling out preoperative IOP as a confounding factor.
Smokers showed significantly lower one-year success rates following trabeculectomy than non-smokers and significant higher amounts of bleb related interventions at one-year follow-up.
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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