Difference in Outcomes between First-Operated vs. Fellow-Operated Eyes in Patients Undergoing Bilateral Trabeculectomies

<div><p>Main Objective</p><p>To compare the course and outcome of first- and fellow-operated eyes in patients who underwent bilateral trabeculectomies and to investigate the factors associated with the difference.</p><p>Methods</p><p>Preoperative characteristics, including the interval between surgeries, were compared between the first- and fellow-operated eyes in 42 patients who underwent bilateral trabeculectomies. Postoperative intraocular pressure and bleb vascularity, using postoperative anterior segment photos, were compared at various time points between the first- and fellow-operated eyes. Surgical success was evaluated at 1 year after surgery and at the final follow-up. Factors affecting the difference between the first and fellow eyes were analyzed.</p><p>Results</p><p>There was no significant difference in success or failure rates at 1 year postoperatively and at the final follow-up between the first- and fellow-operated eyes. Early postoperative IOP and the degree of bleb vascularity were higher in the fellow-operated eyes (<i>P</i> = 0.001 and 0.003, respectively at week 1 postoperative). The difference in IOP between the first- and fellow-operated eyes was greater in patients whose interval between surgeries was shorter than 3 weeks (<i>P</i> = 0.026).</p><p>Conclusions</p><p>In patients undergoing bilateral trabeculectomies, early postoperative IOP was higher in the fellow-operated eyes than the first-operated eyes; the difference was greater when the interval between surgeries was shorter. The first-operated eye may influence the early postoperative inflammatory response in the fellow-operated eye. Our findings have clinical implications for planning treatment of patients who may need bilateral surgery.</p></div

Representative photographs of bleb vascularity at postoperative week 1.

<p>Vascularity was more severe in the fellow-operated eye (B) than in the first-operated eye (A). The interval between these surgeries was 2 weeks.</p

Success rate of first- and fellow-operated eyes at postoperative year 1.

<p>Success rate of first- and fellow-operated eyes at postoperative year 1.</p

Comparison of bleb vascularity between first- and fellow- operated eyes.

<p>The degree of vascularity was significantly higher in the fellow-operated eyes at postoperative weeks 1 and 2 (<i>P</i> = 0.003 and 0.005, respectively). The examiner was blinded to the information related to the photographs, including which eye was operated first, that were used to grade bleb vascularity at all time points.</p

Kaplan-Meier analysis for surgical success during the follow-up period in first- and fellow-operated eyes.

<p>The curves were not significantly different between the two groups (<i>P</i> = 0.564; log-rank test).</p

Characteristics of first- and fellow-operated eyes.

<p>* Statistically significant value.</p><p>Characteristics of first- and fellow-operated eyes.</p

Success rate of first- and fellow-operated eyes at the final visit.

<p>Success rate of first- and fellow-operated eyes at the final visit.</p

Postoperative complications in first- and fellow-operated eyes.

<p>Postoperative complications in first- and fellow-operated eyes.</p

Difference in IOP between the first- and fellow-operated eyes according to time interval between surgeries.

<p>The IOP difference of postoperative week 1 was significantly greater in patients with a shorter interval between the surgery on the first and fellow eyes. This difference was significantly greater when the interval was less than 3 weeks compared to when it was greater than 3 weeks.</p

Multivariate analysis of the difference between first- and fellow-operated eyes.

<p>* Statistically significant value.</p><p>Multivariate analysis of the difference between first- and fellow-operated eyes.</p