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A. Remky, M. Kaup, N. Plange; Long-Term Effects of Retrobulbar Blood Flow in Patients Undergoing Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4388.
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Previous reports showed increased flow velocities in retrobulbar vessels after glaucoma surgery in the first weeks. Color Doppler imaging was performed to investigate the long-term effect of trabeculectomy on retrobulbar hemodynamics in patients with primary open-angle glaucoma (POAG).
In a prospective study 19 consecutive patients (age 26 - 79 yrs.; 8 f, 12 m) with POAG were included. Color Doppler imaging (Siemens Sonoline Sienna) was performed before, 1-2 weeks and after 6 months up to 24 months after trabeculectomy to determine the peak systolic (PSV) and end-diastolic velocities (EDV) in the ophthalmic artery (OA), central retinal artery (CRA), and the short nasal (NPCA) and temporal (TPCA) ciliary arteries.
Mean follow-up was 416 ± 209 days. In the first post-op period mean IOP decreased after trabeculectomy from 25 ± 6 mm Hg to 9 ± 4 mm Hg (p< 0.0001) and then increased in the further follow-up to 13 ± 3 mm Hg (p = 0.012) without any anti-glaucomatous medication. Color Doppler imaging revealed a significant increase of the EDV of the central artery 1-2 weeks postoperatively compared to pre-op (pre-op: 1.93 ± 0.45 cm/s; post-op: 2.51 ± 0.65 cm/s; p = 0.0016) and of the EDV in the temporal PCA (pre-op: 2.15 ± 0.55 cm/s; post-op: 2.77 ± 0.74cm/s; p = 0.0011). Although IOP increased significantly in further follow-up, EDV of CRA and TPCA remained stable (6-24 month: EDV CRA: 2.54 ± 0.67 cm/s; EDV TPCA: 2.80 ± 0.76 cm/s) - significantly increased to baseline (p< 0.0009 and p< 0.0007 respectively). There was no correlation of IOP decrease (or increase of ocular perfusion pressure) with changes of flow velocities.
End-diastolic velocities of the central artery and of the temporal short posterior ciliary arteries increased after successful trabeculectomy and remained stable in a longer period - even if IOP raised significantly in the follow-up.
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