TY - JOUR
T1 - Long-term Functional Outcomes of Trabeculectomy Revision Surgery
AU - Cardakli, Nur
AU - Weinreb, Samuel F.
AU - Jefferys ScM, Joan L.
AU - Quigley, Harry A.
N1 - Publisher Copyright:
© 2019 American Academy of Ophthalmology
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Purpose: To describe the long-term results of revision surgery for complications from trabeculectomy in a case series from an academic glaucoma service. Design: Retrospective case series. Participants: A total of 310 eyes (310 individuals) who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007–2015. Methods: Retrospective study of patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007–2015. Main Outcome Measures: Success of revision, defined as maintenance of long-term intraocular pressure (IOP) control at or below target, no further glaucoma-related reoperations, no major complications during revision surgery, and no dysfunctional hypotony; need for additional surgery after revision; change in visual acuity (VA) between original trabeculectomy; revision surgery; and last follow-up visit. Results: The mean time between original surgery and revision was 3.1±4.0 years, and the mean follow-up from revision to last examination was 4.4±2.9 years. The overall successes at 1, 2, 5, and 8 years after revision were 76%, 68%, 57%, and 50%, respectively (Kaplan–Meier). The success was similar among revision indications (P = 0.43). The 5-year Kaplan–Meier survival was 60% for eyes undergoing revision for hypotony, 57% for bleb leak, 63% for dysesthesia, and 44% for uncontrolled IOP. Revisions in which the original surgery was performed by surgeons other than present Wilmer faculty were 5 times more likely to fail than cases in which the original surgery was performed by the Wilmer surgeon performing the most trabeculectomy and revision surgeries (P = 0.04). Further surgery after revision was required in 30% of cases during follow-up. Approximately half were additional IOP-lowering procedures, and half were further revisions. Duration of symptoms before revision was not consistently associated with the loss of VA between original surgery and last follow-up. Eyes that lost the most VA before revision surgery for hypotony tended to be the same eyes that regained the most vision after revision; eyes that underwent revision for hypotony with shorter duration of symptoms showed a greater improvement of VA between revision surgery and last follow-up (P = 0.01). Conclusions: Revision of trabeculectomy provided successful resolution of complications associated with trabeculectomy surgery in many cases.
AB - Purpose: To describe the long-term results of revision surgery for complications from trabeculectomy in a case series from an academic glaucoma service. Design: Retrospective case series. Participants: A total of 310 eyes (310 individuals) who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007–2015. Methods: Retrospective study of patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007–2015. Main Outcome Measures: Success of revision, defined as maintenance of long-term intraocular pressure (IOP) control at or below target, no further glaucoma-related reoperations, no major complications during revision surgery, and no dysfunctional hypotony; need for additional surgery after revision; change in visual acuity (VA) between original trabeculectomy; revision surgery; and last follow-up visit. Results: The mean time between original surgery and revision was 3.1±4.0 years, and the mean follow-up from revision to last examination was 4.4±2.9 years. The overall successes at 1, 2, 5, and 8 years after revision were 76%, 68%, 57%, and 50%, respectively (Kaplan–Meier). The success was similar among revision indications (P = 0.43). The 5-year Kaplan–Meier survival was 60% for eyes undergoing revision for hypotony, 57% for bleb leak, 63% for dysesthesia, and 44% for uncontrolled IOP. Revisions in which the original surgery was performed by surgeons other than present Wilmer faculty were 5 times more likely to fail than cases in which the original surgery was performed by the Wilmer surgeon performing the most trabeculectomy and revision surgeries (P = 0.04). Further surgery after revision was required in 30% of cases during follow-up. Approximately half were additional IOP-lowering procedures, and half were further revisions. Duration of symptoms before revision was not consistently associated with the loss of VA between original surgery and last follow-up. Eyes that lost the most VA before revision surgery for hypotony tended to be the same eyes that regained the most vision after revision; eyes that underwent revision for hypotony with shorter duration of symptoms showed a greater improvement of VA between revision surgery and last follow-up (P = 0.01). Conclusions: Revision of trabeculectomy provided successful resolution of complications associated with trabeculectomy surgery in many cases.
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U2 - 10.1016/j.ogla.2019.04.003
DO - 10.1016/j.ogla.2019.04.003
M3 - Article
C2 - 32672545
AN - SCOPUS:85090201247
SN - 2589-4196
VL - 2
SP - 240
EP - 250
JO - Ophthalmology. Glaucoma
JF - Ophthalmology. Glaucoma
IS - 4
ER -