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Vaama Patel, Nariman Nassiri, Chaesik Kim, Justin Tannir, Faisal Ridha Al-Timimi, Lauren Keshishian, Anju Goyal, Mark Juzych, Bret Hughes; Long-term outcomes of surgical treatments for primary angle-closure glaucoma (PACG). Invest. Ophthalmol. Vis. Sci. 2020;61(7):3165.
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To compare the success rates, intraocular pressure (IOP) reduction, and medication reduction of trabeculectomy, Ex-press shunt, and Ahmed valve procedures for patients with primary angle-closure glaucoma (PACG).
Adult patients from 2007 to 2017 with PACG and surgical intervention were included in this retrospective study. For each patient, demographic information, intraocular pressure (IOP), number of glaucoma medications, and visual acuity (VA) were recorded at 3-month intervals for three years. The criteria of success are based on the pre-operative IOP and the number of medications reduced (see Table 1). Those failing to meet the criteria for two consecutive visits or requiring additional glaucoma procedures were considered failure. The treatments were analyzed by a Kaplan-Meier survival curve. A Cox Regression analysis was used to determine pre-operative factors that may be associated with success.
Of 47 patients and eyes included in the study, 17 underwent Ex-press Shunt, 17 underwent Ahmed valve, and 13 eyes underwent a trabeculectomy procedure. Of these subjects, 83% were African American. The mean age was 66.3 ± 15.3 years, mean IOP was 26.4 ± 9.8 mmHg, and the mean pre-operative number of glaucoma medications was 3.3 ± 1.2. Based on Kaplan-Meier analysis, cumulative success for Ex-press shunt was 70.6% at 12 months, 52.9% at 24 months, and 41.2% at 36 months. For the Ahmed valve, cumulative success was 76.9% at 12 months, 46.2% at 24 months, and 36.2% at 36 months. For trabeculectomy, cumulative success was 70.6.1% at 12 months, 41.2% at 24 months, and 34.3% at 36 months. These success rates did not vary significantly from each other (p=0.84). Compared to the Pre-op IOP, the mean IOP for all procedures decreased significantly to 14.6 ± 5.0 at 12 months, 15.5 ±6.4 at 24 months, and 14.0 ±5.1 at 36 months (p<0.0001). The number of medications also significantly decreased for all procedures to 1.2 ± 1.4 at 12 months, 1.8 ± 1.4 at 24 months, and 1.6 ± 1.5 at 36 months (p<0.001). Cox Regression Analysis showed no significant pre-operative factors influencing the success rate of these procedures.
Trabeculectomy, Ahmed valve, and Ex-press shunt are effective in reducing IOP and number of glaucoma medications in patients with primary angle-closure glaucoma
This is a 2020 ARVO Annual Meeting abstract.
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