Abstract
Purpose :
One of the most widely adopted recent modifications made to the trabeculectomy (trab) is the use of antifibrotics (AF). African Americans (AA) were shown to be predisposed to surgical failure before this procedural augmentation. Only one recent study (Nguyen et. al, 2018) compared outcomes of AF-augmented trab amongst AA and Caucasian Americans (CA), albeit with cases that varied in surgical technique and diagnoses. The impact of race on modern trab is not well understood.
Methods :
Primary microtrabeculectomy cases among AA and CA performed between 1/1/2013 and 1/1/2018 were included for this retrospective study. All had the same surgeon and were performed with the same surgical technique with adjunctive mitomycin C. In patients with bilateral surgery, only the first eye was included. Cases with diagnoses other than primary open angle glaucoma and previous ocular surgery in the operative eye were excluded. Outcomes were intraocular pressure (IOP) and topical antihypertensives (drops). Postoperative rates of 5-Fluorouracil (5-FU) injection, needling, suturelysis, late hypotony (past 4 weeks), maculopathy, and bleb leak were noted. Success criteria included IOP ≤ 21 mmHg (Criterion A) and IOP reduction > 20% (Criterion B). Failure was defined as patients who had failed to meet either criteria or had repeat glaucoma surgery. The student’s T-test and Chi squared were used.
Results :
21 AA and 26 CA of the same mean age met criteria. At baseline, AA’s used 2.3 drops and had an IOP of 24.9 mmHg, which improved to 0.6 drops and 11.3mmHg by postoperative year 3 (POY3). CA’s went from 2.8 to 1.4 drops and 27.3mmHg to 11.3mmHg at POY3. IOP and drops were the same among the two groups at all time points – Baseline, POY1, POY1.5, POY2, POY3 (Table1). Criterion A, B, and reoperation rates were comparable to published benchmarks and not significantly different between the two groups (Table 2). Rates of postoperative 5FU, needling, suturelysis, late hypotony, and bleb leak were the same (Table 2).
Conclusions :
In contrast to Nguyen et. al, 2018, this study, which controlled for surgical technique and glaucoma diagnoses, found similar outcomes, postoperative bleb management, and complication rates between the two groups. More research is warranted to ascertain the impact of race on modern trabeculectomy.
This is a 2020 ARVO Annual Meeting abstract.