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Editorial
June 2006

Why Did My Surgery Fail, Doc?

Arch Ophthalmol. 2006;124(6):903-904. doi:10.1001/archopht.124.6.903

Why did my surgery fail, doc? This is a question few surgeons want to hear, and it is always difficult to answer. The surgeon may invoke a number of hypotheses on her own, which might include the adverse effects of previous surgical interventions, the persistence of significant levels of inflammation, or inadequate patient adherence to a complex postoperative regimen. Should the surgeon mention heredity as an explanation for failure?

In this issue of the ARCHIVES, Drs Ishida and Netland1 suggest that heredity may play a role in the success of Ahmed glaucoma valve implantation. In a nonrandomized, retrospective analysis of a series of self-reported cases with African American and white patients, these investigators found a statistically significant difference between these 2 groups when the success of this procedure was evaluated. Success was defined in 2 ways: (1) intraocular pressure (IOP) greater than or equal to 6 mm Hg and less than or equal to 21 mm Hg with or without mediation, no additional surgery, and no light perception; or (2) IOP greater than or equal to 6 mm Hg and less than or equal to 21 mm Hg and attainment of a 20% reduction in IOP compared with baseline. When the first definition was applied to the data, the P value was .03 vs P<.01 when the second definition was used. Ethnicity, age, glaucoma diagnosis, lens status, preoperative IOP, number of preoperative antiglaucoma medications, and number of preoperative incisional and nonincisional surgical interventions were analyzed as potential risk factors for failure. Only ethnicity proved to be significant. Therefore, the authors concluded that African American patients have a greater risk of failure following Ahmed glaucoma valve implantation.

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