Standardization of approaches to repeat glaucoma surgery

Recurrence of sustained intraocular pressure (IOP) elevation occurs in 15% to 35% of cases after glaucoma surgery (GS). The choice of optimal management strategy and timing for repeat GS remains an important and insufficiently studied issue.

PURPOSE. To study the range of opinions and clinical approaches among ophthalmologists in Russia regarding repeat glaucoma surgery in patients with primary openangle glaucoma (POAG).

METHODS. This study consisted of a survey conducted among 606 ophthalmologists from various regions of Russia. Among them, 432 (71%) worked in outpatient clinics, 96 (16%) in hospitals, and 78 (13%) combined both settings. The study used descriptive statistics and comparison of proportions between groups with assessment of statistical significance (p-values).

RESULTS. The vast majority of respondents (77.2% of outpatient physicians and 81.7% of hospital physicians) regularly (weekly, monthly, or quarterly) encounter patients requiring repeat GS.

Significant differences in clinical approaches were identified: 46.9% of hospital surgeons were ready to refer patients for repeat surgery within 1.5 to 6 months, whereas only 33.1% of outpatient physicians supported this strategy (p=0.005). In cases of disease destabilization, 46.9% of hospital physicians favor the "prefer repeat surgery" approach, while outpatient physicians more often (42.1%) opted for "prefer prolonged medical therapy" (p=0.0005). While 98.95% of hospital doctors consider stabilization without therapy as a criterion for complete success of antiglaucoma surgery, 6.2% to 8.9% of physicians from other groups also regarded stabilization with hypotensive medications as a successful outcome.

CONCLUSION. The survey results revealed significant discrepancies between outpatient and hospital ophthalmologists in the management of patients with failed initial GS, particularly regarding the timing of repeat surgery and the choice between surgical and medical strategies. These findings highlight the absence of unified standards and underscore the need for the development of standardized clinical guidelines for managing this complex patient population to improve long-term functional outcomes.

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