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Shunsuke Tsuchiya, Tomomi Higashide, Sachiko Udagawa, Shinji Ohkubo, Kazuhisa Sugiyama; Central Visual Field Defect After Vitrectomy for Epiretinal Membrane or Macular Hole in Glaucomatous Eyes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5041.
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© ARVO (1962-2015); The Authors (2016-present)
Several studies have pointed out the possible reduction in the visual sensitivity after pars plana vitrectomy (PPV) for macular diseases. However, the significance of the adverse effects on glaucomatous eyes is still unknown. Therefore, we performed this study to investigate the visual field changes after PPV for epiretinal membrane (ERM) or macular hole (MH) in glaucomatous eyes.
This is a retrospective review of 28 eyes of 28 patients with open angle glaucoma who underwent PPV (23 or 25 gauges) for ERM or MH at Kanazawa University Hospital by a single surgeon (ERM, 22 eyes; MH, 6 eyes; age, 66.9±8.1 years old). We combined PPV with cataract surgery for phakic eyes (n=23). We used triamcinolone acetonide for ERM removal and the internal limiting membrane peeling. Standard automated perimetry (Humphrey visual field Analyzer II, SITA-standard 30-2 or 24-2 programs) was performed preoperatively and postoperatively (7.0±2.7 months after surgery, range 3-13 months) along with the measurements of best-corrected visual acuity (BCVA) and ganglion cell complex (GCC, retinal nerve finer layer + ganglion cell layer + internal plexiform layer) thickness in the central 10 degrees by spectral domain optical coherence tomography. We measured mean visual field sensitivity from the central 12 points of the 24-2 test points (center), which corresponded to the central 10 degrees, and the rest of test points (periphery), respectively. We evaluated the changes in these parameters after surgery.
Postoperative central sensitivity (21.0±6.8 dB) significantly decreased from the preoperative value (23.1±5.8 dB, p=0.003). In contrast, postoperative peripheral sensitivity (20.8±6.0 dB) significantly increased from the preoperative value (19.8±6.0 dB, p=0.028). BCVA significantly improved after surgery (LogMAR: from 0.15±0.15 to 0.06±0.16, p=0.028). Postoperative GCC thickness (88.2±8.7 µm) was significantly thinner than the preoperative value (118.9±21.5 µm, p<0.001). A multivariate regression analysis showed that the relative postoperative change in the central sensitivity to the peripheral sensitivity was associated with the postoperative GCC thickness (standardised beta coefficient, 0.58; p=0.001).
The visual field sensitivity in the central 10 degrees may deteriorate after vitrectomy for ERM or MH in glaucomatous eyes.
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