Biological processes and clinical variables affecting trabeculectomy surgery outcome

Abstract Purpose: To establish what preoperative clinical factors and tear protein levels influence the trabeculectomy outcome. Methods: In this prospective study, we followed 80 glaucomatous eyes for 5 years after trabeculectomy. Preoperatively, tear fluid samples and clinical data were collected from all patients. Postoperative statuses, i.e., qualified success (QS) in case of 5‐fluorouracil (5FU), needling or restart of glaucoma medication and failure (F) in case of reoperation, were recorded. The patients' postoperative statuses were then compared against the preoperative tear proteomics and clinical variables with Wilcoxon rank sum test. Proteomic pathway analyses were performed using Ingenuity Pathway Analysis (IPA) software. Results: Within 1 year of the surgery, 15 (19%) QS + F patients were detected. Patients with early failure were younger than those with a successful early outcome (64.7 ± 9.5 vs 70.1 ± 7.6 years, respectively, p = 0.04) and according to pathway analysis results, had increased activation of immune responses prior to surgery (all p ‐values <0.05). Overall, 24 (31%) QS + F cases occurred during the 5‐year follow‐up. Pathway analysis revealed that these patients had increased levels of apoptosis prior to surgery (activation z‐score = 2.2, p ‐value = 0.02). Conclusions: These results further emphasize the importance of observing the preoperative state of the ocular surface. The tear proteomic profiles reveal biological functions that are associated with the trabeculectomy outcome.