September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
The effect of trabeculectomy surgery on the central visual field in patients with glaucoma and an established central visual field defect using Micro-perimetry and Optical coherence tomography.
Author Affiliations & Notes
  • Gokulan Ratnarajan
    Ophthalmology, Queen Victoria Hospital, Chalfont St Peter, United Kingdom
    Oxford Eye Hospital, Oxford, United Kingdom
  • Jasleen Kaur Jolly
    Oxford Eye Hospital, Oxford, United Kingdom
    Nuffield Laboratory of Ophthalmology, Oxford, United Kingdom
  • John Salmon
    Oxford Eye Hospital, Oxford, United Kingdom
  • Footnotes
    Commercial Relationships   Gokulan Ratnarajan, None; Jasleen Jolly, None; John Salmon, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2953. doi:
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      Gokulan Ratnarajan, Jasleen Kaur Jolly, John Salmon; The effect of trabeculectomy surgery on the central visual field in patients with glaucoma and an established central visual field defect using Micro-perimetry and Optical coherence tomography.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2953.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Trabeculectomy surgery is considered when more conservative treatment options such as topical treatment or laser have failed to prevent glaucoma progression and is a long established and effective treatment. We investigated the functional and structural effect of trabeculectomy surgery on patients with advanced glaucomatous visual field loss threatening fixation using microperimetry (MP) and optical coherence tomography (OCT).

Methods : Prospective, observational case series of thirty consecutive patients listed for trabeculectomy surgery who had established visual field defects within 10 degrees of fixation had 10-2 Maia MP and optic disc Spectralis OCT pre-operatively, 1 month and 3 month post-operatively. Fellow eyes were used as controls. The study was approved by an ethics and R&D committee: 15/NW/0231.

Results : The mean and standard deviation in MP average threshold values was 19.8 ± 6.8dB in the control eye vs 13.7 ± 5.2dB at baseline, 20.0 ± 6.6dB vs 14.3 ± 5.4dB at 1 month and 19.5 ± 6.9dB vs 13.9 ± 5.5dB at 3 months . A linear mixed model did not show any significant difference following surgery at either timepoint in either eye(p=0.94). The mean and standard deviation in OCT nerve fibre layer thickness was 71 ± 19µm in the control eye vs 54 ± 12µm at baseline, 71 ± 20µm vs 54 ± 12dB at 1 month and 67 ± 19µm vs 55 ± 15µm at 3 months . A linear mixed model did not show any significant difference following surgery at either timepoint in either eye (p=0.98). Kappa agreement between OCT and microperimetry classification of glaucomatous disease was 0.735 (95% confidence interval 0.59 to 0.88), which represents a good agreement.

Conclusions : The results from this case series are encouraging in that the central visual function is preserved in all the patients having trabeculectomy and actually improved in 2 patients.
Whilst a larger sample size with longer follow-up is required to make definitive conclusions, this case series should help guide glaucoma surgeons who are contemplating trabeculectomy surgery on patients with advanced glaucoma threatening fixation who are worried about the risk of “wipe-out”.
MP in conjunction with OCT is a useful method to observe these patients providing both structural and functional parameters.

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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