Impact of prostaglandin-associated periorbitopathy on surgical outcomes of trabeculectomy and ahmed glaucoma valve implantation.

PURPOSE

To evaluate the impact of prostaglandin-associated periorbitopathy (PAP) severity on the surgical outcomes of trabeculectomy (LEC) and Ahmed Glaucoma Valve (AGV) implantation in patients with primary open-angle glaucoma.

METHODS

In this propensity score-matched retrospective cohort study, a total of 106 eyes with uncontrolled glaucoma were included. Postoperative follow-ups were conducted at 1, 3, 6, 9, and 12 months. The severity of PAP was evaluated using the Shimane University PAP (SU-PAP) Grading System, with low severity categorized as a score of 0-1 and high severity as a score of 2-3. The primary outcome was surgical success, defined as either complete success (IOP ≤ 18, ≤15, or ≤ 12 mmHg with ≥ 20% reduction from baseline without medications) or qualified success (same criteria with medications). A Cox proportional hazard model was used to assess the risk of surgical failure for surgical success, with stratification based on PAP severity.

RESULTS

In low PAP severity, AGV group demonstrated a significantly higher risk of surgical failure compared to LEC group across all target IOP levels (complete success: HR (95% CI), 3.92 (1.89, 8.15) for IOP ≤ 12, 4.33 (2.04, 9.20) for IOP ≤ 15, and 4.50 (2.06, 9.83) for IOP ≤ 18; qualified success: HR (95% CI), 3.37 (1.48, 7.69) for IOP ≤ 12, 3.78 (1.73, 8.24) for IOP ≤ 15, and 4.28 (2.02, 9.05) for IOP ≤ 18). In contrast, there was no significant difference in surgical failure between LEC and AGV in higher PAP severity.

CONCLUSION

PAP severity should be considered when selecting a surgical approach for glaucoma.

KEY MESSAGES

WHAT IS KNOWN

Prostaglandin-associated periorbitopathy (PAP) is a common side effect of prostaglandin analogs and may affect intraocular pressure control and surgical outcomes.

WHAT IS NEW

This is the first study comparing trabeculectomy (LEC) and Ahmed Glaucoma Valve (AGV) outcomes stratified by PAP severity In patients with low PAP severity, LEC showed significantly higher surgical success than AGV. No significant difference was found between LEC and AGV in patients with high PAP severity.