Surgical Results of Trabeculectomy among Groups Stratified by Prostaglandin-Associated Periorbitopathy Severity

PURPOSE

To report the role of prostaglandin-associated periorbitopathy (PAP) severity in the surgical effectiveness of trabeculectomy (LEC).

DESIGN

Retrospective observational case series.

PARTICIPANTS

A total of 139 consecutive eyes of 139 Japanese subjects (74 men, 65 women; mean age ± standard deviation, 65.7 ± 10.6 years) who underwent LEC were included. All had primary open-angle glaucoma (POAG), no history of conjunctival incisional surgery, completed all postoperative visits for 12 months, and information on the PAP severity using the Shimane University PAP Grading System (SU-PAP).

METHODS

Data were collected from a medical chart review at 2 hospitals.

MAIN OUTCOME MEASURES

Comparison of surgical success rates among groups stratified by SU-PAP grades 0 to 3 by survival curve analysis using the definitions of failure based on surgical intervention other than laser suture lysis (LSL), intraocular pressure (IOP) reduction below 20%, postoperative IOP exceeding 15 mmHg (definition A) or 12 mmHg (definition B), and a postoperative IOP below 6 mmHg.

RESULTS

Twelve months postoperatively, the success rates of grades 0, 1, 2, and 3 were 86%, 68%, 40%, and 0%, respectively, for definition A (P < 0.0001, log-rank test) and 86%, 61%, 36%, and 0%, respectively, for definition B (P < 0.0001). Interventions other than LSL (P < 0.0001, Cochran-Armitage trend test), IOP reduction less than 20% (P = 0.010), and IOP exceeding 15 mmHg (P = 0.016) or 12 mmHg (P < 0.0001) were associated with surgical failure; IOP under 6 mmHg was not (P = 0.31). The proportional hazard model for definition A showed that compared with grade 0, grade 2 (risk ratio [RR], 5.82, P = 0.0043) and grade 3 (RR, 12.2, P = 0.0003) were associated with surgical failure. For definition B, grade 1 (RR, 3.53, P = 0.040), grade 2 (RR, 6.65, P = 0.0021), and grade 3 (RR, 12.0, P = 0.0003) were associated with surgical failure. Differences in age, gender, preoperative IOP and medications, refractive error, and simultaneous cataract surgery were not associated with surgical failure in both models.

CONCLUSIONS

The preoperative presence of severe PAP worsens the 1-year success rate of LEC in patients with POAG. To retain the surgical effectiveness, treating physicians should prevent patients from progressing to severe PAP, an avoidable side effect, by switching or stopping the causative medications.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Shortening of interpupillary distance after topical prostaglandin analog eye drop application in an ophthalmic surgeon: A case report

Purpose

This study reports a case of interpupillary distance (IPD) shortening after instillation of topical prostaglandin analog (PGA) eye drops.

Observations

The patient was a 36-year-old ophthalmic vitreoretinal surgeon from Tochigi, Japan, with primary open-angle glaucoma and bilaterally instilled PGA eye drops to decrease intraocular pressure. His IPD had been recorded closely based on surgical microscope settings. The patient had a stable IPD for over five years before the use of PGA drops. The patient noticed IPD shortening associated with latanoprost usage since four years. The IPD shortened further twice with temporal switching to bimatoprost. However, the IPD partially recovered both the times on discontinuing the medication over the course of several months.

Conclusions and Importance

Fluctuations in IPD with visible cosmetic changes occur in association with the use of topical PGA eye drops. There might be effects of PGA drops on binocular vision, which are possibly unaddressed and warrant further study.

[Prospects of the use of prostaglandin analogues in the treatment of patients with thyroid eye disease]

Currently, the only effective method of treatment and rehabilitation of patients with inactive thyroid eye disease (TED) is orbital decompression. This review analyzes the prospects of using prostaglandin analogues (PGF2β) to decrease the volume of orbital fat in order to reduce proptosis and periorbital changes in TED. Despite the fact that the available data on the results of using PGF2β analogues in patients with TED are contradictory, were based on short follow-up periods and involved only a small number of patients, we believe that this topic is a very promising avenue for further research.