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S.K. Law, A. Nguyen, D. Hoffman, J. Caprioli; Incidence of Loss (Snuffing) of Central Vision in Patients with Advanced Glaucomatous Visual Field Defects Undergoing Trabeculectomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5491.
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To evaluate the visual outcomes of patients with advanced visual field defects undergoing trabeculectomy.
The medical records of 1304 patients who had trabeculectomy between June 1998 and October 2005 (89 months) were retrospectively reviewed. Patients were excluded if they had uveitic glaucoma, neovascular glaucoma; nonglaucomatous optic nerve, cornea, or retinal diseases; or concurrent surgery with trabeculectomy. Patients were enrolled if the preoperative threshold automated visual field (24–2 or 30–2) had advanced defects defined as: >90% of the test points (excluding the central 4 test points) had sensitivities of <5dB or 3 of the 4 central test points were <5dB. One eye of each patient was enrolled. Outcome measurements include visual acuity, intraocular pressure, and surgical complications.
85 patients (85 eyes) who met the above criteria were enrolled. 22 eyes (25.9%) had a decrease of > 1 line and 6 eyes (7.1%) had > 5 lines loss of Snellen visual acuity at 3 months postoperatively. There were no significant differences between the groups with and without a decrease in visual acuity of >1 line of reduction in Snellen visual acuity regarding to age, gender, glaucoma subtype, and IOP reduction. However, there was a significantly higher rate (28.2%) of surgical complications in patients with greater reduction in visual acuity than patients with less visual acuity decrease (7.1%, p=0.027).
Approximately 7% of glaucoma patients with advanced preoperative visual field defects undergoing trabeculectomy had a severe reduction of central vision, and is significantly associated with surgical complications.
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