Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma.

Abstract

PURPOSE:

To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome.

METHODS:

A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome.

RESULTS:

The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher's exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively.

CONCLUSIONS:

The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.

• Authors: S S Rong, M Y Feng, N Wang, H Meng, R Thomas, S Fan, R Wang, X Wang, X Tang, Y B Liang
• Journal: Eye (London, England) (Eye (Lond)) Vol. 27 Issue 3 Pg. 403-9 (Mar 2013) ISSN: 1476-5454 [Electronic] England
• PMID: 23306726 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Alkylating Agents
• Mitomycin

Topics

• Alkylating Agents (administration & dosage)
• Conjunctiva (drug effects)
• Female
• Follow-Up Studies
• Glaucoma, Angle-Closure (physiopathology, surgery)
• Humans
• Intraocular Pressure (physiology)
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Postoperative Period
• Prognosis
• Surgical Flaps
• Suture Techniques
• Tonometry, Ocular
• Trabeculectomy
• Treatment Outcome