Predictors Of Long-Term Treatment Stability After Surgical Management Of Advanced Glaucoma: A 4-Year Retrospective Study

To identify predictors of long-term intraocular pressure (IOP) stability and surgical success following glaucoma surgery in patients with advanced to end-stage glaucoma.

Single-center retrospective study conducted at a specialized ophthalmology center.

Patients with advanced to end-stage glaucoma undergoing surgical treatment between 2021 and 2025 were retrospectively analyzed. Procedures included minimally invasive glaucoma surgery (MIGS) combined with prostaglandin therapy, trabeculectomy, or implantation of the Ahmed Glaucoma Valve. Outcome measures included mean IOP reduction, medication burden, time to treatment instability, need for additional glaucoma procedures, and postoperative complications over 36–48 months of follow-up. Multivariate analysis was performed to identify factors associated with long-term treatment stability.

A total of surgically treated eyes demonstrated sustained IOP reduction throughout follow-up. Greater baseline IOP and filtration-based procedures were associated with larger pressure reductions. MIGS-based approaches demonstrated a more favorable safety profile with fewer postoperative complications but required ongoing medication in most cases. Filtration surgery and tube implantation achieved greater medication-free success but were associated with higher rates of postoperative hypotony and intervention. Factors associated with improved long-term stability included lower postoperative IOP at 6 months and reduced medication burden during early follow-up.

Surgical management of advanced glaucoma provides sustained IOP control over long-term follow-up. Early postoperative pressure reduction and lower medication requirements may predict long-term treatment stability. Understanding these predictors may help guide surgical selection and postoperative management in patients with advanced disease.