The rate of failure of trabeculectomy and tube shunt surgery in eyes with uveitic glaucoma and ocular hypertension: The purpose of this study is to look at the outcomes of trabeculectomy and tube shunt surgery in a large cohort of patients with uveitis.
Sylvia L Groth, Craig W Newcomb, Wei Yang, Abhishek Payal, Hosne Begum, Naira Khachatryan, R Oktay Kaçmaz, Kurt A Dreger, James T Rosenbaum, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Nirali P Bhatt, C Stephen Foster, Douglas A Jabs, Grace A Levy-Clarke, Jeanine M Buchanich, Gui-Shuang Ying, John H Kempen, Sapna Gangaputra
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Abstract
Purpose: To evaluate the incidence of failure of trabeculectomy vs. tube shunt glaucoma surgery in eyes of patients with uveitis.
Design: Multi-center retrospective cohort study.
Participants: Among 356 eyes of 288 patients with noninfectious inflammatory eye disease undergoing first incisional glaucoma surgery using one of the techniques, 244 eyes had tube shunts (TS) and 112 eyes had trabeculectomy augmented with mitomycin-C (Trab-MMC).
Methods: Standardized chart review was used to collect clinical data over time retrospectively. Cox regression analyses with adjustment for propensity score and inter-eye correlations were performed to compare the incidence of failure of glaucoma surgery between TS and Trab-MMC.
Main outcome measures: Failure of glaucoma surgery of the first five years postoperatively, defined as: (1) IOP≤ 5 mmHg or >21 mmHg at two consecutive visits at least 90 days apart beginning three months after surgery; or (2) reoperation; or (3) complete blindness (no light perception).
Results: The median age was 40.3 years (IQR 13.4-57.3) in the TS group and 44.2 years (IQR 29.0-58.9) in the Trab-MMC group. The median pre-glaucoma surgery IOP was 29.0 mm Hg (IQR 21-35.5) in the TS group and 30.0 mm Hg (IQR 20-38) in the Trab-MMC group. Anterior uveitis was most common location of primary inflammation in both the TS group (52.5%) and Trab-MMC group (55.4%). Failure was observed in the TS group in 23.5%, 27.1% and 30.8% cumulatively through 12, 24, and 36 months respectively vs. 16.1%, 25.6% and 30.0% respectively in the Trab-MMC group. In the propensity score adjusted Cox regression analysis, there was no significant difference in failure incidence rate between the TS and trab-MMC groups (adjusted hazard ratio 1.08, 95% CI 0.65-1.78, p=0.77). Success without requirement for IOP-lowering medicines was observed more frequently in the Trab-MMC group.
Conclusions: TS and Trab-MMC fail frequently with similar incidences when done as the first glaucoma surgery among eyes with uveitis over 5 years of follow-up, but there were more complete successes in the Trab-MMC group compared to the TS group at 12, 24 and 36 months.
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