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Graefe's Archive for Clinical and Experimental Ophthalmology

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27-04-2023 | Glaucoma | Glaucoma

Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity

Authors: Nobuyuki Sato, Masayuki Kasahara, Yusuke Kono, Kazunori Hirasawa, Nobuyuki Shoji

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 9/2023

Abstract

Purpose

To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery.

Method

Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated.

Results

The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05).

Conclusion

The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

Norskov K (1970) Routine tonometry in ophthalmic practice. II five-year follow-up Acta Ophthalmol (Copenh) 48:873–895. https://doi.org/10.1111/j.1755-3768.1970.tb08208.xCrossRefPubMed

Perkins ES (1973) The Bedford glaucoma survey. I. long-term follow-up of borderline cases. Br J Ophthalmol 57:179–185. https://doi.org/10.1136/bjo.57.3.179CrossRefPubMedPubMedCentral

Kitazawa Y, Horie T, Aoki S, Suzuki M, Nishioka K (1977) Untreated ocular hypertension. a long-term prospective study. Arch Ophthalmol 95:1180–1184. https://doi.org/10.1001/archopht.1977.04450070078004CrossRefPubMed

Lundberg L, Wettrell K, Linner E (1987) Ocular hypertension. a prospective twenty-year follow-up study. Acta Ophthalmol (Copenh) 65:705–708. https://doi.org/10.1111/j.1755-3768.1987.tb07067.xCrossRefPubMed

Armaly MF, Krueger DE, Maunder L, Becker B, Hetherington J Jr, Kolker AE, Levene RZ, Maumenee AE, Pollack IP, Shaffer RN (1980) Biostatistical analysis of the collaborative glaucoma study. I. summary report of the risk factors for glaucomatous visual-field defects. Arch Ophthalmol 98:2163–2171. https://doi.org/10.1001/archopht.1980.01020041015002CrossRefPubMed

Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial G (2002) Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol 120:1268–1279. https://doi.org/10.1001/archopht.120.10.1268CrossRefPubMed

Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA, Mills RP, Group CS (2001) Interim clinical outcomes in the collaborative initial glaucoma treatment study comparing initial treatment randomized to medications or surgery. Ophthalmology 108:1943–1953. https://doi.org/10.1016/s0161-6420(01)00873-9CrossRefPubMed

Collaborative Normal-Tension Glaucoma Study Group (1998) Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 126:487–497. https://doi.org/10.1016/s0002-9394(98)00223-2CrossRef

AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration.the AGIS investigators. Am J Ophthalmol 130:429–440. https://doi.org/10.1016/s0002-9394(00)00538-9CrossRef

10.

Epstein DL, Krug JH Jr, Hertzmark E, Remis LL, Edelstein DJ (1989) A long-term clinical trial of timolol therapy versus no treatment in the management of glaucoma suspects. Ophthalmology 96:1460–1467. https://doi.org/10.1016/s0161-6420(89)32688-1CrossRefPubMed

11.

Kass MA, Gordon MO, Hoff MR, Parkinson JM, Kolker AE, Hart WM Jr, Becker B (1989) Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. a randomized, double-masked, long-term clinical trial. Arch Ophthalmol 107:1590–1598. https://doi.org/10.1001/archopht.1989.01070020668025CrossRefPubMed

12.

Schulzer M, Drance SM, Douglas GR (1991) A comparison of treated and untreated glaucoma suspects. Ophthalmology 98:301–307. https://doi.org/10.1016/s0161-6420(91)32296-6CrossRefPubMed

13.

Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL (2007) Utilization of various glaucoma surgeries and procedures in medicare beneficiaries from 1995 to 2004. Ophthalmology 114:2265–2270. https://doi.org/10.1016/j.ophtha.2007.02.005CrossRefPubMed

14.

Robin AL, Ramakrishnan R, Krishnadas R, Smith SD, Katz JD, Selvaraj S, Skuta GL, Bhatnagar R (1997) A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol 115:969–974. https://doi.org/10.1001/archopht.1997.01100160139001CrossRefPubMed

15.

Khaw P, Wilkins M (1999) Antifibrotic agents in glaucoma surgery. In: Yanoff M, Duker J (eds) Ophthalmology. Churchill Livingstone, London, pp 1–88

16.

Aggarwal SP, Hendeles S (1986) Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol 70:97–99. https://doi.org/10.1136/bjo.70.2.97CrossRefPubMedPubMedCentral

17.

Martinez JA, Brown RH, Lynch MG, Caplan MB (1993) Risk of postoperative visual loss in advanced glaucoma. Am J Ophthalmol 115:332–337. https://doi.org/10.1016/s0002-9394(14)73584-6CrossRefPubMed

18.

Topouzis F, Tranos P, Koskosas A, Pappas T, Anastasopoulos E, Dimitrakos S, Wilson MR (2005) Risk of sudden visual loss following filtration surgery in end-stage glaucoma. Am J Ophthalmol 140:661–666. https://doi.org/10.1016/j.ajo.2005.04.016CrossRefPubMed

19.

Langerhorst CT, de Clercq B, van den Berg TJ (1990) Visual field behavior after intra-ocular surgery in glaucoma patients with advanced defects. Doc Ophthalmol 75:281–289. https://doi.org/10.1007/BF00164842CrossRefPubMed

20.

Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B (1993) Loss of visual acuity after trabeculectomy. Ophthalmology 100:599–612. https://doi.org/10.1016/s0161-6420(93)31597-6CrossRefPubMed

21.

Law SK, Nguyen AM, Coleman AL, Caprioli J (2007) Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol 125:1044–1050. https://doi.org/10.1001/archopht.125.8.1044CrossRefPubMed

22.

Francis BA, Hong B, Winarko J, Kawji S, Dustin L, Chopra V (2011) Vision loss and recovery after trabeculectomy: risk and associated risk factors. Arch Ophthalmol 129:1011–1017. https://doi.org/10.1001/archophthalmol.2011.182CrossRefPubMed

23.

Kobayashi N, Hirooka K, Nitta E, Ukegawa K, Tsujikawa A (2018) Visual acuity and corneal higher-order aberrations after EX-PRESS or trabeculectomy, and the determination of associated factors that influence visual function. Int Ophthalmol 38:1969–1976. https://doi.org/10.1007/s10792-017-0685-1CrossRefPubMed

24.

Sugiyama T, Shibata M, Kojima S, Ueki M, Ikeda T (2011) The first report on intermediate-term outcome of Ex-PRESS glaucoma filtration device implanted under scleral flap in Japanese patients. Clin Ophthalmol 5:1063–1066. https://doi.org/10.2147/OPTH.S23129CrossRefPubMedPubMedCentral

25.

Beltran-Agullo L, Trope GE, Jin Y, Wagschal LD, Jinapriya D, Buys YM (2015) Comparison of visual recovery following EX-PRESS versus trabeculectomy: results of a prospective randomized controlled trial. J Glaucoma 24:181–186. https://doi.org/10.1097/IJG.0b013e31829e1b68CrossRefPubMed

26.

Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y, Araie M, Collaborative Bleb-Related Infection I, Treatment Study G (2016) Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol 94:e561–e570. https://doi.org/10.1111/aos.13058CrossRefPubMed

27.

Kolker AE (1977) Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 75:539–555PubMedPubMedCentral

28.

Edmunds B, Thompson JR, Salmon JF, Wormald RP (2002) The national survey of trabeculectomy. III early and late complications Eye (Lond) 16:297–303. https://doi.org/10.1038/sj.eye.6700148CrossRefPubMed

29.

Altan C, Ozturker C, Bayraktar S, Eren H, Ozturker ZK, Yilmaz OF (2008) Post-trabeculectomy choroidal detachment: not an adverse prognostic sign for either visual acuity or surgical success. Eur J Ophthalmol 18:771–777. https://doi.org/10.1177/112067210801800518CrossRefPubMed

30.

Takihara Y, Inatani M, Seto T, Iwao K, Iwao M, Inoue T, Kasaoka N, Murakami A, Futa R, Tanihara H (2011) Trabeculectomy with mitomycin for open-angle glaucoma in phakic vs pseudophakic eyes after phacoemulsification. Arch Ophthalmol 129:152–157. https://doi.org/10.1001/archophthalmol.2010.348CrossRefPubMed

31.

Kim BS, Savinova OV, Reedy MV, Martin J, Lun Y, Gan L, Smith RS, Tomarev SI, John SW, Johnson RL (2001) Targeted disruption of the myocilin gene (Myoc) suggests that human glaucoma-causing mutations are gain of function. Mol Cell Biol 21:7707–7713. https://doi.org/10.1128/MCB.21.22.7707-7713.2001CrossRefPubMedPubMedCentral

32.

Gould DB, Miceli-Libby L, Savinova OV, Torrado M, Tomarev SI, Smith RS, John SW (2004) Genetically increasing Myoc expression supports a necessary pathologic role of abnormal proteins in glaucoma. Mol Cell Biol 24:9019–9025. https://doi.org/10.1128/MCB.24.20.9019-9025.2004CrossRefPubMedPubMedCentral

33.

Kwon YH, Fingert JH, Kuehn MH, Alward WL (2009) Primary open-angle glaucoma. N Engl J Med 360:1113–1124. https://doi.org/10.1056/NEJMra0804630CrossRefPubMedPubMedCentral

34.

Liu Y, Allingham RR (2017) Major review: molecular genetics of primary open-angle glaucoma. Exp Eye Res 160:62–84. https://doi.org/10.1016/j.exer.2017.05.002CrossRefPubMedPubMedCentral

35.

Rezaie T, Child A, Hitchings R, Brice G, Miller L, Coca-Prados M, Heon E, Krupin T, Ritch R, Kreutzer D, Crick RP, Sarfarazi M (2002) Adult-onset primary open-angle glaucoma caused by mutations in optineurin. Science 295:1077–1079. https://doi.org/10.1126/science.1066901CrossRefPubMed

36.

Ariani F, Longo I, Frezzotti P, Pescucci C, Mari F, Caporossi A, Frezzotti R, Renieri A (2006) Optineurin gene is not involved in the common high-tension form of primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 244:1077–1082. https://doi.org/10.1007/s00417-005-0079-3CrossRefPubMed

37.

Charlesworth JC, Stankovich JM, Mackey DA, Craig JE, Haybittel M, Westmore RN, Sale MM (2006) Confirmation of the adult-onset primary open angle glaucoma locus GLC1B at 2cen-q13 in an Australian family. Ophthalmologica 220:23–30. https://doi.org/10.1159/000089271CrossRefPubMed

38.

Hauser MA, Sena DF, Flor J, Walter J, Auguste J, Larocque-Abramson K, Graham F, Delbono E, Haines JL, Pericak-Vance MA, Rand Allingham R, Wiggs JL (2006) Distribution of optineurin sequence variations in an ethnically diverse population of low-tension glaucoma patients from the United States. J Glaucoma 15:358–363. https://doi.org/10.1097/01.ijg.0000212255.17950.42CrossRefPubMed

39.

Ritch R, Schlotzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315. https://doi.org/10.1016/s0039-6257(00)00196-xCrossRefPubMed

40.

Aboobakar IF, Johnson WM, Stamer WD, Hauser MA, Allingham RR (2017) Major review: exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology. Exp Eye Res 154:88–103. https://doi.org/10.1016/j.exer.2016.11.011CrossRefPubMed

Title: Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity
Authors: Nobuyuki Sato
Masayuki Kasahara
Yusuke Kono
Kazunori Hirasawa
Nobuyuki Shoji
Publication date: 27-04-2023
Publisher: Springer Berlin Heidelberg
Keywords: Glaucoma
Trabeculectomy
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 9/2023
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06076-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

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