Abstract
Purpose :
The failure of trabeculectomy has been related to the chronic ocular surface inflammation produced by the long-term use of topical anti-glaucoma medications. Our aim was to find out whether previous topical hypotensive therapy also influences the outcome of another type of glaucoma surgery, non-penetrating deep sclerectomy (NPDS).
Methods :
This is a retrospective study of patients diagnosed of open-angle glaucoma who underwent NPDS at the Glaucoma Unit, Valladolid Clinic Hospital, Spain in the last 5 years. Eyes were divided into two groups based on intraocular pressure (IOP) values at 12 months after NPDS: success group (IOP<21 mmHg) and failure group (IOP>21 mmHg). All patients were under topical hypotensive therapy with up to 3 active substances in commercialized topical formulations, either separately or in combination. Normal distribution of variables was determined with Shapiro-Wilks test. The relationship between both groups was statistically analyzed in 5 variables by Mann-Whitney test: number of active substances used, drops per day, benzalkonium chloride (BAK)-containing drops per day, polyquad-containing drops per day, and duration of pharmacological treatment.
Results :
We included 48 eyes from 34 patients (16 females, 18 males; mean age 72.5±13 years). Previous mean IOP was 22.2±6.4 mmHg. Patients had been using topical anti-glaucoma therapy for 5.4±6.8 years before surgery. NPDS surgical success rate was 87.5%, meaning that there were 42 patients in the success group and 6 in the failure group. Change in IOP 12 months after NPDS was -7.9±6.8 mmHg in the success group and +1.3±11.8 in the failure group, respectively. The number of drops per day was significantly (p=0.037) greater in the failure group (3.2±0.4) than in the success group (2.5±0,8). There were not significant differences between groups in the other 4 variables analyzed, although the number of BAK-containing drops per day and the duration of pharmacological treatment were higher in the failure group.
Conclusions :
The negative impact of long-term hypotensive topical treatment in NPDS outcome seems to be related with the amount of eyedrops instilled per day. Consequently, medical treatment should be minimized as much as possible before opting for this surgical anti-glaucoma therapy.
This is a 2021 ARVO Annual Meeting abstract.