June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Factors Associated with Unplanned Return to Operating Room after Trabeculectomy Surgery
Author Affiliations & Notes
  • Nur Cardakli
    Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Michael V Boland
    Wilmer Eye Institute, Baltimore, Maryland, United States
  • David S Friedman
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Nur Cardakli, None; Michael Boland, None; David Friedman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 963. doi:
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      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.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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