Abstract
Purpose :
The impact of age on postoperative success in trabeculectomy (TLE) remains debated. This study investigates the association between TLE outcome and age, accounting for confounding factors. Variables were adjusted using three approaches: (1) stratified analysis by categorizing patients into age groups, (2) regression analysis, and (3) propensity score matching, aiming to discern whether age plays a pivotal role in influencing TLE outcomes.
Methods :
This retrospective study enrolled 305 patients who underwent initial TLE procedures from 2019 onward. Patient demographics were stratified into four age groups, and logistic regression analysis was employed to identify factors contributing to surgical success. Additionally, propensity score matching based on median age compared surgical outcomes between younger and older patients. The explanatory variables included age, glaucoma type, surgeon, preoperative intraocular pressure and mean deviation of the Humphrey visual field test, axial length, anti-thrombotic drug use and combined cataract surgery. Surgical success at 1-year post-surgery was defined by two criteria: achieving intraocular pressure between 5-12 mmHg with a ≥30% reduction compared to pre-surgery levels and no additional glaucoma surgeries (Criterion A); achieving intraocular pressure between 5-15 mmHg with a ≥20% reduction compared to pre-surgery levels and no additional glaucoma surgeries (Criterion B).
Results :
Stratified analysis by age unveiled a significant increase in exfoliation glaucoma (XFG) and a trend towards shorter axial lengths with advancing age (both p<0.0001). Older age groups were more likely to experience surgical failure in Criterion A and Criterion B (p<0.01/0.21). Univariate analysis showed age as a significant factor in surgical failure for Criterion A (p<0.05) and a nearly significant factor for Criterion B (p=0.12). However, this trend was not evident in multivariate analysis (p=0.23/0.88), where XFG became a significant factor for surgical failure (both p<0.001) in Criterion A and B. Propensity score matching revealed no significant differences in surgical success rates for Criteria A and B between younger and older patients (p=1.00/0.88).
Conclusions :
Age is not a primary determinant of failure in TLE; however, the increasing incidence of XFG with aging suggests the potential for poorer outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.