Long-term success after trabeculectomy in open-angle glaucoma: results of a retrospective cohort study

Abstract

ObjectiveTo evaluate the long-term outcomes of trabeculectomy (TE) surgery in a large cohort with a minimum follow-up of 3 years.DesignRetrospective cohort study.SettingUniversity Eye Hospital, Germany.ParticipantsThree hundred and seventy-nine patients with open-angle glaucoma underwent TE with mitomycin C (MMC) between January 2013 and February 2017 with a minimal follow-up of 3 years. Eligible patients were identified via an electronic surgical case register.InterventionsAll patients had undergone TE with MMC following a set surgical protocol. To assess the influence of cataract surgery following TE, eyes which underwent cataract surgery at least 6 months after TE were matched 1:3 by sex and age to eyes who did not undergo cataract surgery during the follow-up period.Main outcome measuresPrimary outcome was the proportion of surgical success based on intraocular pressure (IOP), surgical complications, the need for revision surgery, loss of light perception and the need for additional pressure-lowering medication.ResultsThe mean follow-up time was 6 (±0.8, IQR: 5.4–6.5) years. Seventy-three per cent of eyes achieved qualified surgical success at the last follow-up (IOP≥5 mm Hg and ≤18 mm Hg, without surgical complications or complete loss of vision) but necessitated additional medical therapy, complete surgical success with no additional medical therapy was achieved in 69% of eyes. There was no significant difference in the success probability between eyes that had undergone cataract surgery after TE and those that had not (p=0.45).ConclusionsThe results demonstrate a high and stable success rate of TE after a mean follow-up time of approximately 6 years, that is, not affected by later cataract surgery.

Predicting Glaucoma Surgical Outcomes Using Neural Networks and Machine Learning on Electronic Health Records

“…Improving the performance over previous work is a significant achievement and marks a milestone toward developing clinical decision support tools that could help in glaucoma surgical planning by predicting expected outcomes of glaucoma surgery. Such a tool could prove very useful as 175,000 glaucoma surgeries are performed each year in the United States alone, 15 and the outcome of these surgeries can be widely variable 2 and unpredictable.…”

“…However, the outcome of glaucoma surgery can be variable and unpredictable, with some patients experiencing surgical “failure” at early time points and others maintaining good disease control for lengthy periods of time. 2 Although a number of predictors of glaucoma surgical failure or success have been demonstrated, most previous work has considered relatively few patient features. 2 Because every patient and their disease comprise a unique and complex combination of many clinical factors, it can be difficult for clinicians to precisely predict their disease course and postsurgical outcomes.…”

“… 2 Although a number of predictors of glaucoma surgical failure or success have been demonstrated, most previous work has considered relatively few patient features. 2 Because every patient and their disease comprise a unique and complex combination of many clinical factors, it can be difficult for clinicians to precisely predict their disease course and postsurgical outcomes.…”