Abstract
Background: To determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy. Methods: In this prospective interventional case series, we analyzed for one year 80 consecutive primary open angle glaucoma patients who underwent mitomycin-augmented trabeculectomy. Bleb morphology was scored using the Indiana bleb appearance grading scale (IBAGS). Success was defined as IOP ≤15 mmHg at 12 months. We applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC). Results: The mean age of participants was 62±12.3 years in the success and 63.2±16.3 years in the failure group (P= 0.430) with equal gender distribution (P=0.911). IOPs on day 1, 7 and 30 were similar in both (P= 0.193, 0.639, and 0.238, respectively.) The AUC of IOP at day 1, day 7 and 30 for predicting a successful outcome was 0.355, 0.452, and 0.80, respectively. The AUC for bleb morphology parameters of bleb height, extension, and vascularization, on day 14 were 0.368, 0.408, and 0.549, respectively. Values for day 30 were 0.428, 0.563, and 0.654. IOP change from day 1 to day 30 was a good predictor of failure (AUC=0.838, 95% CI: 0.704 to 0.971) with a change of more than 3 mmHg predicting failure with a sensitivity of 82.5% (95% CI: 68 to 91%) and a specificity of 87.5% (95% CI: 53 to 98%). Conclusions: IOP on day 30 had a fair to good accuracy while bleb features failed to predict success except bleb vascularity that had a poor to fair accuracy. An IOP increase more than 3 mmHg during the first 30 days was a good predictor of failure.
Highlights
IntroductionThe number of trabeculectomies has sharply declined in the last decades in many developed countries[1,2]
For several reasons, the number of trabeculectomies has sharply declined in the last decades in many developed countries[1,2]
The purpose of our study was to validate in our patient population the accuracy of the early postoperative intraocular pressure (IOP) and bleb morphology (Indiana Bleb Appearance Grading Scale (IBAGS)) as a test to predict a failure of trabeculectomy at 12 months
Summary
The number of trabeculectomies has sharply declined in the last decades in many developed countries[1,2]. More surgeons are trained in microincisional glaucoma surgeries[3,4] which can be performed sooner due to a superior risk profile[5]; laser trabeculoplasty devices have become more affordable and are used as the first line of treatment[6,7]; and prostaglandin analogues are available as generic, less expensive eye medications, further reducing the number of trabeculectomies[6]. Trabeculectomies have a considerable complication rate[12], they remain a common primary procedure for advanced glaucoma because they lower intraocular pressure (IOP) effectively and are not as expensive as epibulbar glaucoma drainage devices[13], which involve a comparable surgical effort and risk profile. Even with the most personalized postoperative care, the individual wound healing and tissue remodeling make predicting a successful outcome difficult. To determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy. We applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC)
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