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Predictive Value of Early Postoperative IOP and Bleb Morphology in Mitomycin-C Augmented Trabeculectomy

Esfandiari, Hamed and Pakravan, Mohammad and Loewen, Nils A. and Yaseri, Mehdi (2017) Predictive Value of Early Postoperative IOP and Bleb Morphology in Mitomycin-C Augmented Trabeculectomy. (Submitted)

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Purpose: To determine the predictive value of postoperative bleb morphological features and intraocular pressure (IOP) on the success rate of trabeculectomy.

Methods: In this prospective interventional case series, we analyzed for one year 80 consecutive open angle glaucoma patients who underwent mitomycin-augmented trabeculectomy. Bleb morphology was scored using the Indiana bleb appearance grading scale (IBAGS). Success was defined as IOP ≤15 mmHg with or without medications at 12 months. We tested for IOP and bleb morphological differences between groups, applied a multivariable regression analysis and determined the area under the receiver operating characteristic curve (AUC).

Results: Age and gender were equally distributed (62.3±13.1 years, P=0.911). IOP of patients with a successful outcome did not differ from unsuccessful ones on day 1, 7 and 30 (all P≥0.2)). The AUC of IOP at day 1, day 7 and 30 for predicting a successful outcome was 0.355, 0.452, and 0.80, respectively. The AUC for bleb morphology parameters, bleb height, extension, and vascularization, on day 14 were 0.368, 0.408, and 0.549, respectively. Values for day 30 were 0.428, 0.563, and 0.654. IOP change from day 1 to day 30 was a good predictor of failure (AUC=0.838, 95% CI: 0.704 to 0.971) with a change of more than 3 mmHg predicting failure with a sensitivity of 82.5% (95% CI: 68 to 91%) and a specificity of 87.5% (95% CI: 53 to 98%).

Conclusion: The postoperative IOP on day 30 had a fair to good accuracy while the bleb features failed to predict a successful outcome. An IOP increase by as little as more than 3 mmHg during the first 30 days was a good predictor of failure.


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Item Type: Article
Status: Submitted
CreatorsEmailPitt UsernameORCID
Esfandiari, Hamed
Pakravan, Mohammad
Loewen, Nils A.loewen.nils@gmail.comNAL580000-0001-7167-1213
Yaseri, Mehdi
Date: 7 March 2017
Date Type: Submission
Schools and Programs: School of Medicine > Ophthalmology
Refereed: No
Funders: Eye and Ear Foundation of Pittsburgh, Initiative to Cure Glaucoma
Article Type: Research Article
Date Deposited: 17 Mar 2017 17:46
Last Modified: 17 Mar 2017 17:46


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