Abstract
Purpose :
To determine the long-term, all-cause mortality rate in patients with neovascular glaucoma (NVG) treated with tube shunt surgery (TS) in a tertiary referral center.
Methods :
Retrospective cohort study of 320 eyes of 320 NVG patients who had TS from 1996-2019. Clinical and demographic data were recorded. Death dates were determined using publicly-available Internet data. Kaplan-Meier survival curves were created; subgroups were analyzed with a Bonferroni-corrected p<.007 for pre-operative visual acuity (VA), intraocular pressure (IOP), diabetes and complications (i.e. renal, cardiac, stroke, amputation), insulin dependency, and disease control and laterality. Multivariable regression was used to evaluate odds ratios adjusted for these factors.
Results :
Median survival after TS was 9.24 years (range 0.00-23.81 years) with 50.7% (151/298 patients) 10-year mortality. Mean±SD patient age at first TS was 59.5±18.5 years; 42% were white, 29% were black. 188 (59%) patients had diabetes. Patients requiring additional ipsilateral treatment had lower mortality (HR=0.45, 95% CI 0.27-0.72; p=.001) and 27.7% (12/45 patients) 10-year mortality. In multivariable analysis, older age (OR= 0.90, 95% CI 0.85-0.94; p<.0001), insulin use (OR=0.25, 95% CI 0.06-0.81; p=.028), and white race (vs. black, OR=0.30, 95% CI 0.10-0.84; p=.028) were associated with increased mortality. Other variables were not associated with mortality in either analysis.
Conclusions :
NVG has been suggested to negatively impact mortality. The 10-year, all-cause mortality rate for NVG patients who had TS is greater than 50% with median survival <10 years. This rate is worse than a historical control group of diabetic patients with minimal diabetic retinopathy, better versus ocular ischemic syndrome, and worsens with age and insulin dependency. These results may be useful for pre-operative counseling and decision-making. In conclusion, this retrospective analysis revealed that NVG patients requiring TS have poor long-term survival; older and insulin-dependent individuals exhibit worse mortality rates.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.