Abstract
Purpose
To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome.
Methods
A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher’s exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome.
Results
The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher’s exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively.
Conclusions
The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.
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Acknowledgements
We thank Dr Lan Ping Sun, the vice president of Handan 3rd Hospital, for the logistic support provided by the hospital. We also thank Dr Tian Cai Ye, professor of ophthalmology, Zhongshan Ophthalmic Center, for their valuable advices to develop the study protocol and case report form. We also thank the coordinators: Mrs Ying Luo, in Angyang Eye Hospital, Anyang, Henan Province; Dr Li Xia Guo, Dr Hong Yu Cui and Dr Zhi Hong Zhang at Department of Ophthalmology, Handan 3rd Hospital, Hebei Province. This work was funded by the National ‘Eleventh Five-Year’ Science and Technology Program, the Ministry of Science and Technology of the PRC grant no. 2007BAI18B08.
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Rong, S., Feng, M., Wang, N. et al. Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma. Eye 27, 403–409 (2013). https://doi.org/10.1038/eye.2012.291
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DOI: https://doi.org/10.1038/eye.2012.291
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