# The Effect of Preoperative Use of High- vs. Low-PAP-Inducing-Potential FP Agonists on the Surgical Outcomes of Trabeculectomy and AGV Implantation

## TL;DR

Using high-PAP-inducing glaucoma medications before surgery may lead to worse outcomes for trabeculectomy, but the effect on AGV implantation is less clear.

## Contribution

This study is the first to compare the impact of high- and low-PAP-inducing FP agonists on both trabeculectomy and AGV implantation outcomes.

## Key findings

- High-PAP FP agonists were linked to significantly lower 2-year survival rates after trabeculectomy.
- High-PAP FP agonists were identified as a significant risk factor for trabeculectomy failure.
- AGV implantation outcomes showed minimal differences between FP agonist groups under strict criteria.

## Abstract

Background: Prostanoid FP receptor agonists (FP agonists) are widely used as first-line therapies for glaucoma but differ in their potential to induce prostaglandin-associated periorbitopathy (PAP), which may affect surgical outcomes. While several studies have reported an association between PAP and trabeculectomy failure, the impact of these agents on tube shunt procedures such as Ahmed glaucoma valve (AGV) implantation is not well established. Methods: We retrospectively analyzed 298 eyes of 221 patients who underwent trabeculectomy (n = 162) or AGV implantation (n = 136) between 2018 and 2023. The eyes were stratified by preoperative FP agonist use into the high-PAP-inducing-potential (bimatoprost or travoprost) and low-PAP-inducing-potential (latanoprost or tafluprost) groups. The primary outcome was the cumulative 2-year surgical survival rate under three intraocular pressure (IOP)-based definitions. Results: In the trabeculectomy group, the high-PAP-potential group had significantly lower 2-year survival rates than the low-PAP-potential group under all definitions. Cox proportional hazards analysis identified use of a high-PAP-potential FP agonist as a significant risk factor for surgical failure. In the AGV group, a difference between groups was seen only under the most lenient definition, with no differences under stricter criteria. Conclusions: The preoperative use of high-PAP-potential FP agonists is associated with poorer outcomes after trabeculectomy. Although the effect on AGV implantation appears limited, it may still influence early postoperative results. These findings underscore the need to consider PAP risk and medication history when selecting surgical procedures for glaucoma.