Effect of Digital Compression on Intraocular Pressure after One Year of Trabeculectomy

Abstract

Purpose : Trabeculectomy is still the method of choice for surgical treatment of glaucoma, especially for advanced cases. Follow-up and after-treatment manuevers are of outstanding importance for the postoperative clinical course and long-term outcomes. Ocular digital massage (ODM) is a commonly post-operative manuever that promotes aqueous flow through the surgical site, enlarging the bleb, reducing IOP and inhibiting scar formation. There is scarce information regarding the impact of ODM on trabeculectomy outcomes after at least one year of follow-up. The objective of this study is to evaluate the effect of ODM in a cohort of cases with at least one year of post-operative course.

Methods : A retrospective analysis of an electronic database of cases which underwent trabeculectomy in a glaucoma center (November 2017 - December 2020) was carried out. Cases with complete clinical information and a follow-up of at least one year after trabeculectomy were included in the study. The analyzed variables were best-corrected visual acuity, visual field stability, glaucoma stage of severity, number of antiglaucoma medications, time of trabeculectomy follow-up, site of ODM, effect of ODM on IOP and bleb formation. ANOVA analysis was performed for continuous variables. A p-value of ≤ 0.05 was considered as statistically significant.

Results : From 668 cases identified with trabeculectomy, 501 eyes of 416 patients (mean age, 64.2±13.9 years; 61% female; 68% POAG) were included in the study. One hundred and thirty one cases (25.9%) required ODM, and they were significantly younger (mean age, 59.5±.9.8 years, p=0.0012; 69% female; 52% POAG) and with higher pre-operative mean IOP, as compared with the eyes not requiring ODM (20.4±9.2 mm Hg vs 18.3±8.4 mm Hg, p=0.017). Eyes requiring ODM had an early (prior to 8 days) IOP of 16.6±.6.8 mm Hg, decreasing after the maneuver to 11.7±3.4 mm Hg (p<0.0001). After one year, mean IOP (15.3±6.0 mm Hg) of eyes not requiring ODM (n=478) was significantly greater (p=0.04) than IOP (14.0±5.1 mm Hg) of eyes requiring ODM (n=104). No persistent or serious complication was related to ODM.

Conclusions : Findings from the current report suggests that ODM after trabeculectomy is a post-operative maneuver that can induce a sustained benefit to reduce IOP and has to be investigated in well-designed trials in order to recognize its real applicability and limitations, in the long-term.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.