Abstract
Purpose :
To evaluate the occurrence of pigment dispersion (PD) after trabeculectomy (TE) with intraoperative moxifloxacin and its impact on safety and success. Systemic or oral moxifloxacin has been previously associated with different pigmentary syndromes; however, limited information is available about its effect when used intracamerally during trabeculectomy.
Methods :
All consecutive patients with glaucoma who underwent trabeculectomy with mitomycin (Moorfields Safer Surgery technique) between 2018 and 2021 were retrospectively included. All surgeries were performed at the Department of Ophthalmology of the University Hospital of the Autonomous University of Nuevo León by the same surgeon who applied intracameral moxifloxacin at the end of the surgery in all surgeries. PD was defined as the presence of new pigment in the anterior chamber (AC) or the bleb following TE. Success was defined as intraocular pressure (IOP) <22, >5, at least 20% IOP reduction, and no additional glaucoma surgery, irrespective of the use of glaucoma medications.
Results :
Fifty-two patients (62 eyes) were included, the mean age was 65.1 (SD: 12.6 range:15-89) years, 40 females (64.5%) and 22 males (35.5%). The mean follow-up time was 2.1 years (SD: 1.1). PD was present in 30.6% (n=19) of eyes after the TE; among these, only four eyes had previous pigmentary glaucoma. In 4 patients, the development of PD was an acute episode that appeared 3-5 weeks post-surgery, with new free pigment floating in the AC, inflammation, and photophobia. In one of these patients, iris transillumination appeared in the following weeks, and the trabeculectomy failed.
The overall success at the last visit was 61.3%, with a mean survival of 3.1 years (95% IC 2.62 to 3.44). There was no significant difference in the mean survival between the 19 patients with any PD and the 43 without any sign of PD (log rank:0.278). However, there was a trend toward longer survival in patients without PD. The 4 patients with acute PD had a similar survival, with a success rate of 75%, and there was no significant diferrence compared to those who did not present them (log rank:0.393).
Conclusions :
Pigment dispersion after trabeculectomy appeared in 30.6% of patients in this series of patients in wich moxifloxacin was used intracamerally. 6.5% of patients developed an acute episode of PD. There could be a trend toward shorter survival in patients who develop PD after TE with moxifloxacin.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.