1. QUICK DESIGN GUIDE (--THIS SECTION DOES NOT PRINT--) This PowerPoint 2007 template produces a 36”x60” professional poster. You can use it to create your research poster and save valuable time placing titles, subtitles, text, and graphics. We provide a series of online tutorials that will guide you through the poster design process and answer your poster production questions. To view our template tutorials, go online to PosterPresentations.com and click on HELP DESK. When you are ready to print your poster, go online to PosterPresentations.com. Need Assistance? Call us at 1.866.649.3004 Object Placeholders Using the placeholders To add text, click inside a placeholder on the poster and type or paste your text. To move a placeholder, click it once (to select it). Place your cursor on its frame, and your cursor will change to this symbol. Click once and drag it to a new location where you can resize it. Section Header placeholder Click and drag this preformatted section header placeholder to the poster area to add another section header. Use section headers to separate topics or concepts within your presentation. Text placeholder Move this preformatted text placeholder to the poster to add a new body of text. Picture placeholder Move this graphic placeholder onto your poster, size it first, and then click it to add a picture to the poster. RESEARCH POSTER PRESENTATION DESIGN © 2012 www.PosterPresentations.com QUICK TIPS (--THIS SECTION DOES NOT PRINT--) This PowerPoint template requires basic PowerPoint (version 2007 or newer) skills. Below is a list of commonly asked questions specific to this template. If you are using an older version of PowerPoint some template features may not work properly. Template FAQs Verifying the quality of your graphics Go to the VIEW menu and click on ZOOM to set your preferred magnification. This template is at 100% the size of the final poster. All text and graphics will be printed at 100% their size. To see what your poster will look like when printed, set the zoom to 100% and evaluate the quality of all your graphics before you submit your poster for printing. Modifying the layout This template has four different column layouts. Right-click your mouse on the background and click on LAYOUT to see the layout options. The columns in the provided layouts are fixed and cannot be moved but advanced users can modify any layout by going to VIEW and then SLIDE MASTER. Importing text and graphics from external sources TEXT: Paste or type your text into a pre-existing placeholder or drag in a new placeholder from the left side of the template. Move it anywhere as needed. PHOTOS: Drag in a picture placeholder, size it first, click in it and insert a photo from the menu. TABLES: You can copy and paste a table from an external document onto this poster template. To adjust the way the text fits within the cells of a table that has been pasted, right-click on the table, click FORMAT SHAPE then click on TEXT BOX and change the INTERNAL MARGIN values to 0.25. Modifying the color scheme To change the color scheme of this template go to the DESIGN menu and click on COLORS. You can choose from the provided color combinations or create your own. © 2013 PosterPresentations.com 2117 Fourth Street, Unit C Berkeley CA 94710 posterpresenter@gmail.com Student discounts are available on our Facebook page. Go to PosterPresentations.com and click on the FB icon. A trabeculectomy is a surgical intervention for glaucoma to lower intraocular pressure (IOP). Previous research has shown that trabeculectomies are less successful in eyes that have had previous surgery that injures the conjunctiva, including extracapsular cataract surgery, scleral tunnel phacoemulsification, and pterygium surgery. These surgeries involving the conjunctiva promote scarring by increasing conjunctival fibroblasts and inflammatory cells. One prospective study from Japan compared trabeculectomy success in phakic and pseudophakic eyes 1. In this study, the patients with pseudophakic eyes had undergone cataract surgery involving a small, conjunctival incision. The study found that phakic eyes had higher likelihood of maintaining controlled IOPs after trabeculectomies compared to the pseudo-phakic eyes. INTRODUCTION OBJECTIVES We performed a retrospective chart review at UC Davis from 2007 to 2015 using trabeculectomy billing codes. Exclusion Criteria: Age ≤ 18 years Pre-trabeculectomy IOP <18 mm Hg Previous intraocular or conjunctival surgery (other than cataract surgery) Prior complicated phacoemulsification surgery (vitreous loss, ACIOL) Chronic or recurrent uveitis If both eyes qualified for the study, the eye with the most recent trabeculectomy was excluded. Main Variables: Independent Variable: Lens status: phakic eyes vs. pseudophakic eyes. Primary Outcome Variables: IOP failure analysis Absolute IOP for each measurement window (post op month 3, 6, etc). Secondary Outcome Variables: Time to failure for Cox survival analysis IOP at various time points relative to pre-surgical baseline for each measurement window Reason for failure Type of complication Other reasons to return to OR Clinical interventions after surgery (5FU, laser suture lysis, etc) Difference in LogMar Vision between groups at each study time point Failure Criteria: IOP-based IOP > 21 mm Hg and/or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months IOP ≤ 5 mm Hg on 2 consecutive follow-up visits after 3 months with loss of vision of ≥ 2 lines Reoperation for glaucoma Loss of light perception METHODS Study Population 138 eligible patients: 105 phakic patients and 33 pseudophakic patients Average time between cataract surgery and trabeculectomy: 4.5 years ± 4.1 years Only 4 patients (12%) underwent trabeculectomy within one year of cataract surgery DISCUSSION This study suggests that clear corneal phacoemulsifcation does not affect subsequent trabeculectomy failure rates. No statistically significant differences in IOP changes from baseline between the two groups at any of the time period windows post- surgery (p>0.15). Of the trabeculectomies performed on patients with prior cataract surgery, 18.2% of the trabeculectomies failed in comparison to 24.7% performed on patients without prior cataract surgery, (p=0.77). Survival analysis did not show a statistically significant difference in time until failure. Therefore, there was not evidence to show that clear corneal phacoemulsification affects trabeculectomy success or failure. Limitations: Retrospective study Relatively small sample size, decreased power Pseudophakic patients were significantly older REFERENCES 1.Takihara Y, Inatani M, Ogata-Iwao M, et al. Trabeculectomy for open-angle glaucoma in phakic eyes vs in pseudophakic eyes after phacoemulsification: a prospective clinical cohort study. JAMA ophthalmology. Jan 2014;132(1):69-76. 2.Supawavej C, Nouri-Mahdavi K, Law SK, et al. Comparison of results of initial trabeculectomy with mitomycin C after prior clear-corneal phacoemulsification to outcomes in phakic eyes. Journal of glaucoma. Jan 2013;22(1):52-59. ACKNOWLEDGMENTS I would like to thank Dr. Edie De Niro for her guidance and support throughout this project. Additionally, I would like to thank Dr. Michele Lim and Dr. James Brandt for their expertise and mentorship overseeing this project. Additionally thanks to Dr. Ilana Traynis and Dr. Mitch Watnik for their contribution to the data collection and statistical analysis. To determine if clear-corneal phacoemulsification prior to trabeculectomy is associated with higher trabeculectomy failure rates compared to trabeculectomy alone. This study aims to provide support to guide clinical management of glaucoma. Future plans: According to our power calculations, we will need 91-96 virgin eyes and 57-60 pseudophakic eyes to detect a different of 3 mmHg IOP between the two groups. We need to double the sample size of pseudophakic eyes. Continue to collect data over the next three years to increase the sample size for analysis at later time. NEXT STEPS Kara Brodie, MPhil., Jennifer Edith De Niro, M.D., Michele Lim, M.D., James Brandt, M.D., Mitch Watnik, PhD., Ilana Traynis, M.D. University of California – Davis, School of Medicine Does prior clear corneal phacoemulsification increase failure rate for trabeculectomy? RESULTS Pseudophakic Eyes (n= 33)Phakic Eyes (n= 105) ReasonTotalPercent ReasonTotalPercent IOP too high13% IOP too high76.6% IOP too low0 54.7% Additional Glaucoma surgery 515.2% Additional Glaucoma surgery 1312.4% NLP0 11% Total:618.2% Total:2624.7% Table 1. Reasons for Failure Success Rate Time (years) However, another study 2, which compared similar groups showed no statistically significant difference in intraocular pressure (IOP) outcomes. Shortcomings of the two studies include that cataract surgery in the first study involved a conjunctival incision, and trabeculectomy surgery in the second study did not involve the use of anti-metabolite (anti-scarring) medications which are now used ubiquitously. Our study is a retrospective study that compares the IOP outcomes of patients undergoing trabeculectomy surgery with anti- metabolite in patients who are phakic and in those who are pseudo- phakic after clear corneal cataract surgery (no conjunctival incision). Figure 3. Figure 1. Comparative Success Rates between Phakic and Pseudophakic Eyes 1