Abstract
Purpose :
At ARVO 2019, the authors introduced a novel, minimally invasive, fornix-based microtrabeculectomy procedure with adjunctive mitomycin C yielding a success rate comparable to other published rates of trabeculectomy (poster #B0083). This study aims to further assess the efficacy of this modified technique in specifically patients with prior incisional glaucoma surgery.
Methods :
This is a retrospective single surgeon case series. Microtrabeculectomies cases with or without concomitant phacoemulsification performed by a single surgeon between 1/1/2013 and 1/1/2018 were included in the study. Patients who did not have prior history of incisional glaucoma surgery in the operative eye or had follow-up of less than one year were excluded. Primary outcomes were surgical success (IOP ≤21 mmHg [criterion A] or IOP reduction ≥20% [criterion B] from baseline) and failure (need for subsequent glaucoma surgery in the operative eye, eg. trabeculectomy, tube shunt, etc.). T-Test & Chi-Squared Test were used for analysis.
Results :
29 cases met criteria for inclusion. Baseline demographics and primary outcomes for included patients are provided in Table 1. Included patients had an average age of 70.9 years with a roughly 1:1 male:female split. 90% had a diagnosis of primary open angle glaucoma, 48% had prior laser glaucoma surgery, and 45% had prior cataract surgery. Mean IOP in mmHg was 24.57 at baseline, which improved at POY1 (13.66, p<0.01), POY2 (13.81, p<0.01), and POY3 (13.16, p<0.01) (Table 2). Primary outcome of success per criterion A was observed in 96.4% of patients at 1 year, 76.9% at 2 years, and 76.2% at 3 years. Primary outcome of success per criterion B was observed in 78.5% of patients at 1 year, 65.3% at 2 years, and 57.1% at 3 years. No cases required additional surgery at 1 year.
Conclusions :
Patients who have had previous incisional glaucoma surgery are known to have worse subsequent surgical outcomes. In our sample, the majority of patients were able to achieve a satisfactory intraocular pressure through post-operative year 3 (with comparable rates to Rajendrababu et. al, 2019; Rodriguez-Una et. al, 2017), and none required additional glaucoma surgery within the first year. Iris sparing fornix-based microtrabeculectomy with mitomycin C is an efficacious option for patients with prior incisional glaucoma surgery.
This is a 2020 ARVO Annual Meeting abstract.