Abstract
Purpose :
Anterior chamber viscoelastic installation is a common procedure for postoperative hypotension after trabeculectomy with mytomycin C (TET). It increases the intraocular pressure (IOP) by reducing flow through the scleral flap. However, it could be supposed that this reduced flow within the critical postoperative healing phase could negatively affect the overall outcome. Therefore, we investigated long-term outcomes.
Methods :
Retrospective study of 71 eyes with postoperative viscoelastic filling (cohesive viscoelastic, Healon) and 89 eyes (control group) that underwent TET between 2008-2016. We compared Best-Corrected Visual Acuity (BCVA), IOP, number of antiglaucomatous eye drops and the potential need of an additional operation at seven different times (pre-op, post-op, year 1-5). Failing criteria were defined as the occurrence of one or more of the following: IOP greater than 21mmHg, IOP lower than 5 mmHg, less than 20% reduction of the IOP compared to baseline or the need of an additional IOP-lowering intervention.
Results :
The average IOP at baseline was 27.3 mmHg in the Healon group and 24.8 mmHg in the control group (p=0.082). One year after TET, the IOP was reduced to 14.1 mmHg in the Healon group and to 15.0 mmHg in the control group (p=0.365). The number of failed TET (see above-mentioned criteria) at year 1 was n=7 (14%) in the Healon group and n=26 (33.8%) in the control group (p=0.013).
At year 5, the mean IOP was 14.3 mmHg in the remaining 15 patients of the Healon group and 14.1 mmHg in the remaining 33 patients in the control group (p=0.868). The number of failures at year 5 was n=3 (20.0%) in the Healon group and n=11 (33.3%) in the control group (p=0.346).
The need of topic antiglaucomatous medication after operation was reduced from 3.0 to 0.6 (year 1) and 1.4 (year 5) in the Healon group and from 3.0 to 1.0 and 1.4 in the control group (p=0.07 year 1, p=0.851 year 5).
Conclusions :
This data shows that the postoperative installation of Healon is a safe way to treat hypotension after TET. Also during a 5 year follow-up no significant difference in BCVA, IOP, antiglaucomatous eyedrops and re-operations could be found between the two groups. Additionally, the number of failures defined due to the above mentioned criteria do not show a significant difference between both groups. Based on this data, Healon does not have a negative effect on the long-term outcome of TET.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.