Long-term Functional Outcomes of Trabeculectomy Revision Surgery
| Autor: | Samuel Weinreb, Nur Cardakli, Joan L. Jefferys ScM, Harry A. Quigley |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Reoperation Intraocular pressure medicine.medical_specialty Time Factors Visual acuity genetic structures medicine.medical_treatment Visual Acuity Glaucoma Trabeculectomy Humans Medicine Intraocular Pressure Retrospective Studies Dysesthesia business.industry Retrospective cohort study General Medicine medicine.disease eye diseases Surgery Treatment Outcome Additional Surgery Female medicine.symptom business Glaucoma Open-Angle Follow-Up Studies Trabeculectomy revision |
| Zdroj: | Ophthalmology Glaucoma. 2:240-250 |
| ISSN: | 2589-4196 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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