Abstract
Purpose :
The aim of the study is to establish what preoperative factors influence the trabeculectomy outcome.
Methods :
In this prospective study, we followed 80 glaucomatous eyes for 5 years after trabeculectomy. At baseline, prior to surgery, tear fluid samples and clinical data were collected from the patients. All postoperative complications, i.e., needling, restart of a glaucoma medication and reoperation, were recorded. The patients’ postoperative statuses (success (S) vs qualified success (QS) and failure (F)) were then compared against the baseline tear proteomics and clinical variables with Wilcoxon rank sum test. Proteomic pathway analyses were performed using Ingenuity Pathway Analysis (IPA) software.
Results :
One year after surgery, 15 (19%) QS+F patients were recorded. Respective numbers 3 and 5 years after surgery were 20 (26%) and 23 (38%). According to pathway analysis results, patients with QS+F status after first year had a decreased generation of reactive oxygen species (ROS) (P=0.02) and an increased development of vasculature and cell movement of immune cells (all P=0.02) at baseline. Patients with QS+F status 1 and 3 years after trabeculectomy had also inhibited estrogen receptor 2 (ESR2) at baseline according to the upstream analysis (P=0.02 and P=0.04, respectively). The patients with QS+F status 1, 3 or 5 years after surgery had statistically higher baseline IOP in comparison to patients with a successful outcome (median IOP value differences were 7 (P=0.003), 3.5 (P=0.008) and 4.5 (P=0.01) mmHg, respectively).
Conclusions :
Tear proteomics results revealed that the states of biological functions in the ocular surface are associated with the trabeculectomy outcome. In addition to inflammation, the instability of ROS merits further studies to establish whether they could be used as trabeculectomy outcome indicators or as druggable targets to improve the surgical outcome.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.