PURPOSE: Postoperative release of scleral flap closure suture is useful in trabeculectomy combined with cataract surgery. We determined risk factors for early filtration failure requiring suture release during the first month after primary glaucoma triple procedure. METHODS: The medical records of 71 consecutive patients with primary open-angle glaucoma who underwent a primary glaucoma triple procedure (primary trabeculectomy, phacoemulsification, and posterior chamber intraocular lens implantation) were reviewed. Suture release had been performed in 24 of the patients for early filtration failure with postoperative intraocular pressure greater than the target value during the first postoperative month. The long-term filtration failure was defined according to 2 criteria based on medical dependency and requirement of additional surgical procedure for intraocular pressure control. Cox proportional hazards multivariate analysis was performed to identify independent risk factors. RESULTS: African American race (P = .02), more than 2 preoperative glaucoma drugs (P = .02), and intraocular pressure greater than 14 mm Hg during the first postoperative week (P = .006) were identified as significant independent risk factors requiring suture release for filtration failure during the first postoperative month. Their significance was further confirmed by Kaplan-Meier survival analysis with Mantel-Cox log-rank test (P = .03, P = .02, and P = .001, respectively). CONCLUSIONS: African American race, more than 2 preoperative medications, and intraocular pressure greater than 14 mm Hg in the first postoperative week are major independent risk factors for initial filtration failure requiring suture release during the first month after primary glaucoma triple procedure. Presence of the risk factors may warrant a more aggressive antiproliferative regimen and/or earlier suture release.
PURPOSE: Postoperative release of scleral flap closure suture is useful in trabeculectomy combined with cataract surgery. We determined risk factors for early filtration failure requiring suture release during the first month after primary glaucoma triple procedure. METHODS: The medical records of 71 consecutive patients with primary open-angle glaucoma who underwent a primary glaucoma triple procedure (primary trabeculectomy, phacoemulsification, and posterior chamber intraocular lens implantation) were reviewed. Suture release had been performed in 24 of the patients for early filtration failure with postoperative intraocular pressure greater than the target value during the first postoperative month. The long-term filtration failure was defined according to 2 criteria based on medical dependency and requirement of additional surgical procedure for intraocular pressure control. Cox proportional hazards multivariate analysis was performed to identify independent risk factors. RESULTS: African American race (P = .02), more than 2 preoperative glaucoma drugs (P = .02), and intraocular pressure greater than 14 mm Hg during the first postoperative week (P = .006) were identified as significant independent risk factors requiring suture release for filtration failure during the first postoperative month. Their significance was further confirmed by Kaplan-Meier survival analysis with Mantel-Cox log-rank test (P = .03, P = .02, and P = .001, respectively). CONCLUSIONS: African American race, more than 2 preoperative medications, and intraocular pressure greater than 14 mm Hg in the first postoperative week are major independent risk factors for initial filtration failure requiring suture release during the first month after primary glaucoma triple procedure. Presence of the risk factors may warrant a more aggressive antiproliferative regimen and/or earlier suture release.
Authors: Brent Siesky; Alon Harris; Aditya Belamkar; Ryan Zukerman; Avery Horn; Alice Verticchio Vercellin; Kristen A Mendoza; Paul A Sidoti; Francesco Oddone Journal: J Glaucoma Date: 2022-03-29 Impact factor: 2.290