Eyes with hypotony may fail less often after trabeculectomy

San Francisco-Eyes with hypotony after trabeculectomy might fare better than those without hypotony, a new study shows. 

If supported by further studies, the finding could change the way surgeons look at low IOP in glaucoma surgery, said Anne Coleman, MD, PhD, during the Shaffer-Hetherington-Hoskins Lecture at the 2016 Glaucoma 360 meeting.

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“We automatically say if you have a pressure of less than 5 [mm Hg] or less than 6 [mm Hg], you’re a failure,” said Dr. Coleman, director, Jules Stein Eye Institute Center for Community Outreach, University of California, Los Angeles. “Our results are showing that might not be the case-you might do at least as well as people who don’t have hypotony, maybe a little bit better.”

The definition of hypotony varies, with some authorities using an IOP of less than 6.5 mm Hg, and others at most 5 mm Hg.

In trials, investigators have measured the incidence at follow-up times of varying lengths after trabeculectomy. Partly as a consequence, incidence rates have ranged from 7.2% to 42.2% in observational studies and 1.6% to 12.4% in trabeculectomy clinical trials, Dr. Coleman said.

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Potential causes include overfiltration after trabeculectomy, bleb leaks, and decreased aqueous production by the ciliary body.

Anne Coleman, MD, PhD speaks with Ophthalmology Times at Glaucoma 360.

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