Purchase this article with an account.
Nur Cardakli, Michael V Boland, David S Friedman; Factors Associated with Unplanned Return to Operating Room after Trabeculectomy Surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):963.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To identify factors associated with unplanned return to the operating room (OR) for trabeculectomy surgeries performed by surgeons at an academic glaucoma service.
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.
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).
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.
This PDF is available to Subscribers Only