Effect of tobacco smoking on outcomes of trabeculectomy / Efeito do tabagismo nos desfechos da trabeculectomia

ABSTRACT Purpose: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. Methods: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. Results: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). Conclusion: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

RESUMO Objetivo: Avaliar o efeito do tabagismo nos desfechos da trabeculectomia. Métodos: Uma revisão retrospectiva do gráfico de pacientes com glaucoma submetidos à trabeculectomia foi realizada por um único cirurgião entre 2007 e 2016. Os gráficos foram examinados para uma história documentada de condição de fumante antes da cirurgia. Variáveis pré-operatórias clínicas e demográficas e clínicas foram registradas. Os pacientes foram divididos em dois grupos de acordo com sua história de tabagismo em fumantes e não fumantes. Quaisquer Intervenções relacionadas à bolha, por exemplo, injeções de 5-fluorouracil + lise de sutura com laser, ou revisão da bolha realizada durante o período pós-operatório foram observadas. O sucesso foi definido como pressão intraocular > 5 mmHg e < 21 mm Hg sem (sucesso completo) ou com (sucesso qualificado) medicamentos hipotensores oculares. A falha foi identificada como violação dos critérios mencionados acima. Resultados: O estudo incluiu 98 olhos de 83 pacientes com idade média de 70,7 ± 11,09 anos, sendo 53% (44/83) dos pacientes do sexo feminino. O diagnóstico mais comum foi o glaucoma de ângulo aberto primário com 47 casos (47,9%). O Grupo de fumantes incluiu 30 olhos de 30 pacientes. Os fumantes, quando comparados aos não fumantes, apresentaram uma melhor acuidade visual pré-operatória significativamente pior (p=0,038), maior espessura central da córnea (p=0,047) e maior pressão intraocular pré-operatória (p=0,011). A taxa de sucesso de um ano para a cirurgia de trabeculectomia foi de 56,7% no Grupo de fumantes contra 79,4% no Grupo de não fumantes (p=0,020). O tabagismo apresentou razão de chances para falha de 2,95 95% de IC (1,6-7,84). Conclusão: Os fumantes demonstraram uma taxa de sucesso significativamente menor em um ano após a trabeculectomia em comparação com os não fumantes e uma maior necessidade de intervenções relacionadas à bolha.

Effect of tobacco smoking on outcomes of trabeculectomy.

PURPOSE: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. METHODS: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. RESULTS: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). CONCLUSION: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

Graft-free Ahmed valve implantation through a 6 mm scleral tunnel.

OBJECTIVE: To evaluate the safety, efficacy, and cost savings of Ahmed glaucoma valve (AGV) tube implantation through a 6-mm scleral tunnel (graft-free technique). DESIGN: Retrospective cohort study. METHODS: The 95% confidence interval for fractional survival at any particular time was calculated using the Kaplan-Meier method. Failure was defined as (i) intraocular pressure (IOP) <6 mm Hg or >21 mm Hg or <20% IOP reduction on 2 consecutive visits after 12 months; (ii) additional surgical intervention to control IOP; or (iii) no light perception. RESULTS: Eighty-four eyes were implanted with graft-free AGV with a success rate of 83% at 2 years. Fourteen eyes failed: 4 no light perception, 1 hypotony, 1 elevated IOP, 5 secondary glaucoma surgeries, 2 AGV extractions, and 1 corneal decompensation. The rate of transient hypotony peaked at 33% on postoperative day 1, reducing to 4% by 6 weeks. Transient flat anterior chamber developed in 8% of eyes. Eight percent of eyes experienced a hypertensive phase (mean IOP = 28 mm Hg). Preoperatively, eyes received 3.8 units of glaucoma medication on average. Postoperatively, 8 eyes required no medication for IOP control. Of the eyes requiring postoperative glaucoma medication, 33% restarted during week 4; an additional 25% of eyes were restarted 6 weeks postoperatively. By 6 months, eyes were on average using 2.2 units of glaucoma medication. Hyphema (18%) was the most common early postoperative complication. The rates of conjunctival and scleral erosion by 2 years were 2.4% and 0%, respectively. Within our institution, excluding valve cost, there was a 39%-45% ($192-$376) cost reduction with the graft-free technique. CONCLUSIONS: The safety and efficacy of a 6-mm scleral tunnel is comparable to conventional scleral-graft method.

Meta-analysis of 1- versus 2-Site Phacotrabeculectomy.

TOPIC: Comparison of efficacy of intraocular pressure (IOP) reduction between 1- versus 2-site phacotrabeculectomy. CLINICAL RELEVANCE: The last systematic review concluded that there was weak evidence to suggest that 2-site phacotrabeculectomy provides 1- to 2-mmHg lower IOP than 1-site surgery. Since this study, there have been further publications on this topic, stimulating this meta-analysis. METHODS/LITERATURE REVIEWED: Randomized controlled trials comparing 1- versus 2-site phacotrabeculectomy were searched through August 2009 using MEDLINE and the Cochrane Registry with the keyword phacotrabeculectomy. Inclusion criteria were prospective randomized controlled trials, a minimum of 12 months of follow-up, and English language. Quality of the trials was assessed using Cochrane collaboration's tool of assessing risk of bias. The main outcome measure was IOP, and secondary outcomes included number of glaucoma medications, visual acuity, complications, and surgical time. RESULTS: Ten articles were included. There was no statistically significant difference in the amount of IOP reduction between 1- and 2-site phacotrabeculectomy. The pooled IOP decreases from baseline (95% confidence interval) were: 7.85 mmHg (6.76-8.92 mmHg) versus 5.83 mmHg (4.72-6.94 mmHg) at 1 month; 8.03 mmHg (7.38-8.67 mmHg) versus 7.03 mmHg (6.35-7.71) at 3 months; 7.78 (7.14-8.42) versus 6.75 (6.04-7.46) at 6 months; 6.44 (5.47-7.41 mmHg) versus 6.68 mmHg (5.56-7.81 mmHg) at 12 months; 7.17 mmHg (6.45-7.89 mmHg) versus 6.56 mmHg (5.77-7.35 mmHg) at 24 months; and 7.76 mmHg (7.02-8.49 mmHg) versus 7.14 mmHg (6.36-7.92 mmHg) at 36 months for 1- versus 2-site phacotrabeculectomy, respectively. There was no significant difference in the reduction in glaucoma medications or change in visual acuity at any time point. CONCLUSIONS: There is no significant difference in IOP reduction between 1- and 2-site phacotrabeculectomy.