Abstract
Purpose :
To identify factors associated with unplanned return to the operating room (OR) for trabeculectomy surgeries performed by surgeons at an academic glaucoma service.
Methods :
Retrospective review of 410 eyes (410 persons) that underwent trabeculectomy surgery by surgeons at the Wilmer Eye Institute between January 2014-December 2016: 205 eyes that returned to OR at any time in the postoperative course for a glaucoma- or trabeculectomy-related surgery and 205 controls that were time-matched within 2 months. Cox proportional hazard models with a univariate threshold of inclusion of p<0.10 were constructed to identify factors associated with unplanned reoperation after trabeculectomy, both within the first 180 postoperative days and at any time during postoperative follow-up.
Results :
Eyes with postoperative choroidal effusion (HR=3.21, p<0.001), hyphema (HR=2.30, p=0.029), and other complications such as vitreous hemorrhage and dislocated IOL (HR=2.02, p=0.048) had an increased risk of unplanned reoperation within the first 180 days. A higher maximum IOP prior to trabeculectomy was associated with a decreased risk of unplanned return to the OR both within the first 180 postoperative days (HR=0.98, p=0.014) and at any time postoperatively (HR=0.98, p=0.002). Eyes with bleb leak (HR=2.88, p<0.001), choroidal effusion (HR=2.63, p<0.001), elevated IOP refractory to medical treatment (HR=5.11, p<0.001), hypotony maculopathy (HR=2.85, p=0.015), suprachoroidal hemorrhage (HR=9.11, p=0.003), and the above other complications (HR=1.87, p=0.012) had an increased risk of unplanned reoperation at any time postoperatively. Eyes that underwent a combined trabeculectomy and cataract extraction had a decreased risk of unplanned reoperation at any time postoperatively (HR=0.69, p=0.030), as did patients not using an oral carbonic anhydrase inhibitor prior to the trabeculectomy (HR=0.65, p=0.050).
Conclusions :
In this large academic practice with multiple surgeons, unplanned reoperation after trabeculectomy surgery was largely associated with postsurgical complications that required time-sensitive surgical intervention. Additional patient-specific and surgical factors may be associated with unplanned reoperation; further studies are warranted to elucidate these relationships.
This is a 2020 ARVO Annual Meeting abstract.