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Risk of Corneal Edema Following Glaucoma Surgery: A Retrospective Chart Review - 5337

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2:27 PM, Samedi 21 Juin 2025 (5 minutes)
Author’s Name(s): Veronica Pentland, Rachel Martin, RJ Campbell, Davin Johnson

Author’s Disclosure Block: Veronica Pentland, none; Rachel Martin, none; RJ Campbell, none; Davin Johnson, none

Abstract Body
Purpose:To determine and compare the long-term risk of corneal edema across different surgical approaches, including trabeculectomy, traditional glaucoma drainage devices (GDDs), Xen stents, and minimally invasive glaucoma surgeries (MIGS). Secondary objectives included identifying risk factors associated with corneal edema and reporting outcomes of patients that progress to corneal transplant. Study Design: Retrospective chart review. Methods: All adult patients undergoing glaucoma surgery by a single surgeon at Kingston Health Sciences Centre over a 20-year period were included. Corneal edema was defined as persistent, irreversible corneal edema beginning at least 1 month after surgery.Kaplan Meier survival curves along with univariate and multivariate Cox proportional hazard models were generated to assess outcomes. Covariates in the model included age at surgery, sex, eye laterality, mitomycin C and carbonic anhydrase inhibitor exposure, presence of a flat anterior chamber, and type of glaucoma. Ethical approval for the study was obtained from the KingstonHealth Sciences and Affiliated Teaching Hospitals Research Ethics Board. Results: There were 327 charts reviewed and 354 eyes met inclusion criteria. The mean follow up duration was 4.44 years (range 0 months-19.33 years) and the mean age at the time of surgery was 74 years. The mean time from first glaucoma surgery to onset of corneal edema was 6 years.At 5, 10, and 15 years post-surgery, the probability of remaining free from corneal edema was 93%, 80%, and 71%, respectively. GDD surgery was associated with a significantly higher risk of corneal edema compared to trabeculectomy (hazard ratio [HR]: 2.65, 95% confidence interval [CI]: 1.15-6.09, p=0.0215). In contrast, survival without corneal edema at 5 and 10 years was 94.4% for MIGS recipients. At 5 years post-surgery, eyes with Xen stents had 97.5% survival. Neither Xens nor MIGS had a statistically different hazard ratio relative to trabeculectomy in the multivariate analysis. The number of glaucoma surgeries was the strongest independent predictor of corneal edema, with each additional surgery increasing the risk by 94% (HR: 1.94, 95% CI: 1.29-2.91, p=0.001). Among the 20 eyes that progressed to corneal transplant, 55% experienced transplant failure. Conclusions: This study demonstrates that the long term risk of corneal edema is significantly increased in GDD recipients relative to trabeculectomy patients. Further, MIGS and Xen stents provide less invasive surgical options for glaucoma with lower long-term risk of corneal edema. The number of glaucoma surgeries an eye undergoes is an independent risk factor for corneal edema. These findings should be considered in the preoperative counseling of glaucoma patients.

Veronica Pentlan

Conférencier.ère

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