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Cassie Nabors Confait, Omolola Idowu, Meghan Moroux; Changes in Cup-to-Disc Ratio Following Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2941.
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To evaluate the changes in cup-to-disc area ratio as seen on confocal scanning laser ophthalmoscopy (CSLO) following trabeculectomy in patients with primary open angle glaucoma and to determine the correlation of post-operative intraocular pressure with any changes in cup-to-disc ratio observed.
Individual patient records for all patients that underwent trabeculectomy at the University of Mississippi Medical Center between 2007 and 2014 were reviewed in a retrospective chart review series. Pre-operative and post-operative intraocular pressure (IOP) and cup-to-disc area ratio (C:D) measurements obtained by CSLO were reviewed. The study eyes were divided into three groups based on IOP at 12 months status-post trabeculecotmy (Group 1 = 0-10 mmHg, Group 2 = 11-15 mmHg, and Group 3 = >15 mmHg). For each group, the pre-operative and post-operative C:D, as measured by CSLO, were then compared to determine any relative change. A reversal of C:D was defined as any negative change in C:D post-operatively as compared to pre-operative measurements.
Of 479 eyes that underwent trabeculectomy at the University of Mississippi Medical center between 2007 and 2014, 36 eyes (35 patients) were included in the study. The majority of patients excluded were for failure of follow-up or for absence of CSLO data within specified pre-operative and post-operative range. At 12 months status-post trabeculecotmy, 25% of eyes (n=9) had an IOP of <10 mmHg, 44.4% (n=16) had an IOP of 11-15 mmHg, and 30.6% (n=11) had an IOP of >15 mmHg. There was found to be no statistically significant difference in pre-operative C:D between the 3 groups. The mean pre-operative and mean post-operative C:D for each group were then compared in order to determine the relative change (Figure 1). It was determined that C:D reversal occurred in 88.9% of patients in Group 1, 43.75% of patients in Group 2, and 27.27% of patients in Group 3.
The results of this study reveal that lower post-operative IOP is associated with an increased likelihood of C:D reversal. It was determined that obtaining a post-operative IOP of <10 mmHg led to mean reversal of C:D. Additionally, patients with a post-operative IOP of 10-15 experienced a mean stabilization of C:D while those with IOP >15 had continued increase in C:D indicating continued glaucoma damage.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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