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Trabeculectomy outcomes similar for elderly, younger patients
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The short-term outcomes of trabeculectomy in glaucoma patients older than 80 years were not significantly different from younger patients, researchers reported in a study recently published in the Journal of Glaucoma.
"Glaucoma in the elderly is becoming more prevalent, with the constant increase in the aging population," Duman and colleagues wrote. "The disease may affect an elderly person's quality of life negatively, causing mobility limitations, fear of falling and depressive symptoms.
"The need for surgery depends on the severity of glaucoma, on the needs of the patient and the likelihood that successful surgery will halt glaucoma progression and improve health-related quality of life,” they added.
To assess the outcomes in elderly patients, researchers retrospectively reviewed the charts of trabeculectomy patients who had their procedure at the Wills Eye Hospital between Jan. 1, 2009, and April 30, 2011. The reviews included 86 eyes of patients between the ages of 81 and 94 years old and 86 eyes of patients between the ages of 22 and 79 years old.
Researchers noted surgical complications, intraocular pressure, number of glaucoma medications and visual acuity. Additionally, they identified surgical failure, which was defined as loss of light perception, when IOP was less than 5 mm Hg, when IOP was greater than 21 mm Hg, reoperation for glaucoma or a less than 20% reduction below baseline.
Results showed that postoperative complications and rate of failure were similar between both groups. At 1 year, researchers reported that the failure rate was 29.5% in the younger control group and 31.3% in the elderly group.
"This study found that the elderly patients who underwent glaucoma filtration surgery had similar failure and complications rates compared with younger individuals," the authors concluded. "All decisions regarding treatment need to consider the needs of individual patient's systemic conditions and life expectancy." – by Chelsea Frajerman
Disclosure: The authors report no relevant financial interests.
Perspective
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Carl H. Jacobsen, OD, FAAO
Duman and colleagues in their retrospective chart review study address an interesting question: Is glaucoma filtering surgery as successful for elderly patients as it is for younger patients?
As the authors dutifully mention, this study is replete with confounding factors such as multiple surgeons, different surgical techniques and different types of glaucoma. Although a controlled, prospective study would better answer their question, there are a couple of points of value to the clinician.
The first and obvious conclusion is that surgical success rates are similar for elderly and younger patients. Perhaps age and, presumably, state of general health is not a good reason to forgo filtering surgery in at-risk elders.
Second, the first-year failure rate for filtering surgery was about 30% for both groups. Within 1 year, nearly one in three patients experienced filtering surgery failure. If your local glaucoma surgeon is not as proficient as the experts at Wills Eye Hospital, this failure could be higher in your patient population.
Clearly, early diagnosis and medical/laser treatment are preferred in glaucoma management.
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