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Abstract #8056 Published in IGR 4-3
The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty
The AGIS InvestigatorsAmerican Journal of Ophthalmology 2002; 134: 481-498
PURPOSE: To investigate the association of pre-intervention and post-intervention patient and eye characteristics with failure of argon laser trabeculoplasty (ALT) and trabeculectomy. DESIGN: Cohort study of participants in the Advanced Glaucoma Intervention Study. METHODS: This multicenter study took place between 1988 and 2001. Between 1988 and 1992, 789 eyes of 591 patients aged 35-80 years with advanced glaucoma were randomized to one of two surgical treatment sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy or trabeculectomy-ALT-trabeculectomy. Upon study-defined failure (based on maximum medications, sustained intraocular pressure (IOP) elevation, visual field defect, and disk rim deterioration) of each intervention, patients were offered the subsequent intervention. Potential follow-up was eight to 13 years. This report is based on data from 779 eyes that had at least three months of follow-up. The main outcome measures are failure of ALT and trabeculectomy, whether as first or second interventions. Effect size is measured by the hazard ratio (HR) and its corresponding 95% confidence interval (CI) obtained from Cox multiple regression analysis, where HR corresponds to the coefficient of change in risk associated with a unit increase in a factor. For binary factors, this corresponds to the change in risk in eyes with the factor relative to the risk in eyes without the factor. RESULTS: Pre-intervention factors associated with failure of ALT are younger age (HR = 0.98, CI = 0.96-0.99, p = 0.009) and higher IOP (1.11, 1.08-1.15, p < 0.001). Pre-intervention factors associated with failure of trabeculectomy are younger age (HR = 0.97, CI = 0.95-0.99, p = 0.005) and higher IOP (1.04, 1.01-1.06, p = 0.002), as well as diabetes (2.86, 1.88-4.36, p < 0.001) and any postoperative complication (1.99, 1.35-2.93, p < 0.001). Individual postoperative complications significantly associated with increased risk of failure of trabeculectomy are elevated IOP (3.4, 1.9-6.1, p < 0.001) and marked inflammation (2.4, 1.3-4.6, p = 0.006). CONCLUSIONS: In this study, ALT failure was associated with younger age and higher pre-intervention IOP. Trabeculectomy failure was associated with younger age, higher pre-intervention IOP, diabetes, and one or more postoperative complications, particularly elevated IOP and marked inflammation.
Classification:
12.4 Laser trabeculoplasty and other laser treatment of the angle (Part of: 12 Surgical treatment)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
