Comentarios de Tiago Prata e Dra Daniela L M Junqueira sobre:Ref: Risk factors for choroidal detachmet after trabeculectomy with Mytomycin C.
Haga A, Inatani M, Shobayashi K, Kojima S, Inoue T, Tanihara H.
Clin Ophthalmol. 2013
ditor AssociadoTiago Prata
Este estudo retrospectivo teve como principal objetivo avaliar fatores possivelmente associados ao descolamento de coróide após trabeculectomia com mitomicina C.
Para isso, foram analisados 420 pacientes com glaucoma submetidos à trabeculectomia no hospital universitário de Kumamoto, no Japão. Através da análise de regressão logística, foram investigados diversos fatores, como idade, sexo, subtipo de glaucoma, cirurgia prévia de catarata, pressão intraocular pré e pós-operatória e necessidade de lise de sutura.
Descolamento de coróide foi definido como uma elevação da coróide de aparência sólida observada através do exame fundoscópico. De maneira surpreendente, aproximadamente 19% dos pacientes apresentaram descolamento de coróide após a trabeculectomia (em média, aproximadamente 6 dias após a cirurgia). A pressão intraocular média desses olhos com descolamento foi de 5,5 mmHg. Os dois fatores significativamente associados com a ocorrência de descolamento de coróide foram idade e pressão intraocular pós-operatória. Pacientes mais velhos e com pressão intraocular mais baixa foram os com maior risco. Sabemos que a ocorrência de descolamento de coróide pode comprometer o resultado cirúrgico de uma trabeculectomia. Acreditamos que medidas intra e pós-operatórias visando minimizar a hipotonia ocular em pacientes mais idosos devam ser então consideradas.
Resumo deste artigo
Clin Ophthalmol. 2013;7:1417-21. doi: 10.2147/OPTH.S46375. Epub 2013 Jul 11.
Risk factors for choroidal detachment after trabeculectomy with mitomycin C.
Haga A, Inatani M, Shobayashi K, Kojima S, Inoue T, Tanihara H.
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Abstract
PURPOSE:
To evaluate the risk factors for choroidal detachment after trabeculectomy with mitomycin C (MMC).
MATERIALS AND METHODS:
We retrospectively evaluated 420 patients (420 eyes) with glaucoma who underwent trabeculectomy with MMC between June 1, 2005 and December 31, 2010 at Kumamoto University Hospital, Japan. Choroidal detachment after trabeculectomy was defined as a solid-appearing elevation of the retina and choroid. Logistic multivariable analysis was applied to determine the risk factors for choroidal detachment. The following factors were assessed: gender, age, subtypes of glaucoma, eye laterality, history of previous cataract surgery, preoperative intraocular pressure (IOP; mean of three Goldmann applanation readings recorded on different days), postoperative IOP (mean of seven Goldmann applanation readings recorded on 7 consecutive days after trabeculectomy), and postoperative laser suture lysis.
RESULTS:
Of the 420 patients, 79 (18.8%) revealed choroidal detachments. The mean period between trabeculectomy and choroidal detachment was 6.1 ± 3.6 days. The mean IOP at the time of the choroidal detachment was 5.5 ± 3.6 mmHg. Age (odds ratio [OR] = 1.028/year, P = 0.0068) and postoperative IOP (OR = 0.887/mmHg, P < 0.0001) were risk factors for choroidal detachment after trabeculectomy. The subgroup analysis for eyes with open angle glaucoma (201 patients) revealed that age (OR = 1.060/year, P = 0.0040) and postoperative IOP (OR = 0.898/mmHg, P = 0.0110) were significant risk factors for choroidal detachment after trabeculectomy with MMC.
CONCLUSION:
Among glaucoma patients, older age and lower postoperative IOP are risk factors for choroidal detachment after trabeculectomy with MMC. In eyes with open angle glaucoma, older age and lower postoperative IOP are risk factors for choroidal detachment after trabeculectomy with MMC.
KEYWORDS:
choroidal detachment, intraocular pressure, mitomycin C, trabeculectomy