Glaucoma filtering surgery in the elderly over eighty years old: an analysis of postoperative risks

Abstract

Aim of this retrospective study was to identify the postoperative complications following trabeculectomy with mitomycin C in patients aged 80 years or older at the time of surgery. Additionally, the corresponding risk factors for postoperative complications were analysed. During a defined period between 2005 and 2009 all trabeculectomies in this age group at the Department of Ophthalmology, University of Cologne were identified. Second eye surgery and re-trabeculectomies in the same eye were excluded from data collection. Postoperative ocular hypotony (< 6 mmHg) and hypertony (> 20 mmHg), bleeding, corneal erosion, re-surgery and prolonged postoperative duration of hospital stay were defined as complications. One hundred and twenty eyes of 120 patients were included. The mean age was 83.4 years, 62.5 % patients were female. Eighty nine percent of the eyes were pseudophakic, the mean visual field defect was - 17.3 dB, the mean preoperative intraocular pressure under pressure-reducing medication was 24.1 mmHg. Considering the perioperative complications there was no significant difference depending on the age (80-85 years, n = 79 and > 85 years, n = 41), depending on the type of anesthesia (general, n = 80 and local, n = 40) or depending on antiplatelet (APT)/anticoagulative (ACT) therapy (APT, n = 55 and ACT, n = 16). The postoperative duration of the hospital stay showed significant correlations with the occurrence of corneal erosions, postoperative ocular hypertony, loss of anterior chamber and choroidal detachment. The postoperative risks of antiglaucomatous filtering surgery did not increase with age or comorbidity. However, even minor perioperative complications had direct implications on the duration of the hospital stay.