The current clinical profile of patients eligible for glaucoma surgery and related type of intervention

Abstract

Purpose : Despite timely surgical intervention is crucial for visual outcome and overall success, a large proportion of glaucoma patients are believed to be referred for surgery when damage is already advanced and ocular surface tissues compromised.
The recent introduction of new filtering devices with potentially improved predictability and safety profile may help reshaping the indications for glaucoma surgery.
This retrospective, multicenter, observational study aims to explore the characteristics of patients referred for glaucoma surgery and whether these features influence to the chioce of the type of intervention.

Methods : Records of patients who underwent filtering surgery with [PreserFlo (PF) and XEN] or without devices (trabeculectomy) in 4 Italian tertiary glaucoma centers between 10-2021 and 10-2022 have been retrospectively reviewed. Patients were profiled by analyzing:

- demographics;
- preoperative intraocular pressure (IOP);
- visual field damage [mean deviation (MD) and type of defect];
- status of the lens;
- number of ocular hypotensive agents (OHAs).

Multinomial logistic regression models have been applied to test the relationship between these variables and the type of surgery.

Results : A total of 432 eyes have been included. Clinical characteristics of patients and comparisons between surgery groups are listed in Table I.
Two hundred and six eyes (47.7%) showed an MD worse than -12 dB and 126 (29.1%) had an end stage or tunnel visual field at the time of surgery.
Patients were treated with a mean of 2.6±0.9 OHAs and 15.7% with >3 OHAs (of whom 47% with additional oral acetazolamide). When compared to trabeculectomy, both PF and XEN surgeries were associated with better MD [OR (95%CI) 1.03 (1.0 – 1.06), p<0.05 and 1.07 (1.03 – 1.10), p<0.01 respectively] and higher number of OHAs [OR 1.64 (1.20 – 2.25), p<0.01 and 1.46 (1.20 – 2.25), p<0.05 respectively]. XEN surgery was also associated with higher IOP [OR (95%CI): 1.05 (1.01 – 1.09), p<0.01]. Undergoing PF was associated with younger age [OR (95%CI): (0.95 – 0.99), p<0.01] whereas combined PF and phacoemulsification with older age [OR (95%CI): 1.03 (1.01 – 1.05), p<0.05].

Conclusions : Glaucoma surgery is still proposed as a late option in a large proportion of patients. The use of filtering devices is associated with earlier damage and more intense preoperative therapy.

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

 

Table I. Clinical characteristics of glaucoma patients.