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RESEARCH PRODUCT

What is driving the decision to perform filtering surgery in glaucoma patients?

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Purpose: To assess what is driving the decision to perform a filtering procedure in glaucoma patients. Methods: Retrospective study in one single University center. All the indications for filtering glaucoma surgeries (alone or combined with cataract extraction) performed in 2013 by the same surgeon were reviewed. The indications were as follows: clinical evaluation of the optic disc, visual field progression, progression on imaging (OCT), poor tolerance to medical treatment, poor control of intraocular pressure (IOP) and cataract. Results: The filtering surgeries (n = 159) were as follows: 78 trabeculectomies, 45 combined cataract and deep sclerectomy, 24 combined cataract and trabeculectomy, 9 deep sclerectomies and 3 tubes. The types of glaucoma were as follows: primary open-angle glaucoma (76%), secondary glaucoma (14%) and angle closure glaucoma (10%). Poor control of IOP was the first indication (51%) followed by cataract (13%), clinical evaluation of the optic disc (12%), visual field progression (12%), poor tolerance to medical treatment (11%) and progression on imaging (1%). Conclusions: In this series, the yield of imaging seems very poor to help the decision to perform a filtering procedure in glaucoma patients. The indications for glaucoma surgery may be highly variable according to the country, the practice and the surgeon. A multicenter study should be useful to better define what is driving the indications for glaucoma surgery.