June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Trabeculectomy for normal-tension glaucoma: outcomes over 10 years at a single institution
Author Affiliations & Notes
  • Justin Grassmeyer
    Oregon Health & Science University Casey Eye Institute, Portland, Oregon, United States
  • Wei-Chun Lin
    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Aiyin Chen
    Oregon Health & Science University Casey Eye Institute, Portland, Oregon, United States
  • Footnotes
    Commercial Relationships   Justin Grassmeyer None; Wei-Chun Lin None; Aiyin Chen None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4287. doi:
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      Justin Grassmeyer, Wei-Chun Lin, Aiyin Chen; Trabeculectomy for normal-tension glaucoma: outcomes over 10 years at a single institution. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4287.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Normal-tension glaucoma (NTG) is characterized by glaucomatous optic nerve damage and vision loss despite normal intraocular pressure (IOP). NTG is a challenging condition to treat that often requires very low IOP to halt progression. Trabeculectomy is a common surgical option to achieve such low pressures, but relatively few studies have examined outcomes of trabeculectomy in NTG. This study explored outcomes of NTG patients who underwent trabeculectomy at a single, large, academic center between 2010-2021.

Methods : NTG patients were identified by ICD-9 and 10 code in the electronic medical record. Adults greater than 18 years old who underwent primary trabeculectomy between 2010 and 2021 were included. Outcomes were determined using automated and manual retrospective chart review. Exclusion criteria included short follow-up (< 1 year), incomplete operative note, and combination surgery other than phacoemulsification. IOP readings from the pre-operative and post-operative 1-year (± 2 months) visits were analyzed. Data is expressed as mean ± standard deviation. Statistical significance was determined using paired t-tests.

Results : Over the study period of 11.5 years, a total of 866 patients were diagnosed with NTG. Of these patients, 106 eyes from 86 patients (9.9% of all NTG patients) underwent trabeculectomy. In comparison, 13.6% of patients diagnosed with primary open angle glaucoma (POAG) underwent trabeculectomy. Of the NTG patients that underwent trabeculectomy, 77.4% were female and average age at the time of surgery was 70.6 years. 60 eyes (57% of total) had both pre-operative and 1-year post-operative IOP measurements. For these 60 eyes, average pre-operative IOP was 14.16 ± 2.56 mm Hg. Average IOP at 1 year was 7.76 ± 3.45 mm Hg (p < 0.001), with an average IOP decrease of 6.40 ± 3.56 mm Hg (45.2% decrease). Twenty-two eyes (20.8% of total) required re-operation during the study period. Indications for re-operation included high IOP (45.2%), hypotony (22.6%), bleb leak (22.6%), and other (9.7%).

Conclusions : Trabeculectomy was shown to be an effective method an effective surgery for significantly lowering IOP lowering among a large cohort of NTG patients at this academic center. Re-operation was required for 21% of eyes, and was performed most frequently to address persistently elevated IOP. Trabeculectomy was performed no more frequently for NTG patients than for POAG patients.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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