Glaucoma Surgery During Non-Pandemic vs. Pandemic Periods in a Tertiary Center in Romania

Background and Objectives: This study aims to comparatively evaluate the outcomes of glaucoma surgeries performed by a single surgeon during the non-pandemic period (2019, 2021, and the first quarter of 2022) versus the pandemic year (2020). The analysis focuses on key surgical outcomes, including intraocular pressure (IOP) reduction, intraoperative and postoperative complications, surgical success and failure rates, and their broader clinical implications. Materials and Methods: Out of a total of 66 patients admitted between November 2019 and March 2022, 45 met the inclusion and exclusion criteria and were enrolled in the study. All patients underwent glaucoma surgery conducted by the same surgeon employing a standardized technique (trabeculectomy ± iridectomy ± mitomycin C). The evaluated clinical parameters included preoperative and postoperative IOP values (with specific assessment on the first postoperative day), early and late intraoperative and postoperative complications, as well as postoperative success and failure rates. Results: The majority of glaucoma cases-particularly those of primary open-angle glaucoma-were recorded in 2021 and 2022, in contrast to 2019 and 2020, when pseudoexfoliative and secondary closed-angle glaucomas predominated. Over the observation period, retrobulbar anesthesia was more frequently utilized in 2019. Statistical analysis indicated that the surgical failure rate was not significantly influenced by the presence of complications, patient age, associated comorbidities, or the specific surgical variant performed. Conclusions: The conduct of glaucoma surgery during the pandemic period was marked by substantial operational and clinical constraints when compared to non-pandemic years, primarily as a consequence of decreased patient accessibility and the reprioritization of healthcare resources, despite the acknowledged emergency status of these procedures. Nonetheless, the overall incidence of early intraoperative and postoperative complications remained minimal, with transient intraocular hypotony emerging as the predominant adverse event, observed in ten cases. Across all study cohorts, more than 80% of patients achieved qualified surgical success, while only 18% exhibited surgical failure, underscoring the robustness of standardized operative protocols under variable healthcare conditions. Consistent with the directives of the American Academy of Ophthalmology (AAO) and the European Glaucoma Society (EGS), glaucoma must be regarded as a genuine ophthalmic emergency necessitating prompt surgical intervention when intraocular pressure cannot be adequately managed through pharmacological or laser-based therapies. The current findings reinforce the imperative of timely glaucoma surgery, irrespective of pandemic or non-pandemic circumstances, as a critical measure for averting irreversible optic nerve damage, mitigating functional visual loss, and sustaining long-term ocular integrity.