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Vaida Diliene, Alon Harris, Ingrida Januleviciene, Lina Siaudvytyte, Ruta Barsauskaite, Brent Siesky; Ocular Hemodynamic Changes after Trabeculectomy in Pseudoexfoliative and Primary Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4445. doi: https://doi.org/.
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To evaluate the effects of trabeculectomy on ocular hemodynamic parameters in pseudoexfoliative (PXG) and primary open-angle glaucoma (POAG) and to analyze serum antiphospholipid antibody levels (APLAs) in PXG.
30 open-angle glaucoma patients were included in the prospective study. Intraocular pressure (IOP), ocular perfusion pressure (OPP), blood pressure (BP) and pulsatile ocular blood flow (POBF) were measured 1 day before and 1 month after trabeculectomy. Retrobulbar blood flow (RBF) was measured using Color Doppler imaging in the ophthalmic (OA), central retinal (CRA) and temporal short posterior ciliary (tSPCA) arteries, assessing peak-systolic (PSV), end-diastolic (EDV) velocities and calculated resistance index (RI). Venous blood samples were taken from PXG patients, IgG APLAs levels were assessed. The level of significance was p<0.05.
IOP decreased significantly in both groups after trabeculectomy (from 30.1(7.2) to 15.0(5.1) mmHg in PXG; from 29.1(7.7) to 13.1(5.5) mmHg in POAG, p<0.05). OPP increased significantly from 38.9(10.3) to 55.5(8.6) in PXG and from 40.9(11.0) to 56.7(8.9) in POAG, p<0.05. Both groups showed significant increase in CRA PSV after surgery (from 8.75(2.27) to 9.79(2.31) in PXG; from 8.55(2.59) to 10.11(2.64) in POAG, p<0.05), though significant decrease in RI was observed only in POAG, p<0.05. Both groups showed significant increase in POBF (from 13.09(3.41) to 18.81(5.70) in PXG; from 11.89(5.79) to 19.29(9.02) in POAG, p<0.05). 10 PXG patients had normal APLAs levels 8.7(2.9) GPLU/mL and 4 patients had borderline/increased 22.6(7.1) GPLU/mL. Patients with higher APLAs levels had lower IOP (28.8(4.9)), higher OPP (41.63(8.23)) compared to patients that had normal APLAs, p>0.05. Patients with normal APLAs levels showed significant decrease in IOP (from 30.7(8.1) to (15.2(5.9)), and increases in POBF (from 13.24(3.69) to19.94(5.03)), CRA PSV (from 8.78(2.39) to 9.46(2.17)) and tSPCA PSV (from 7.61(2.15) to 8.35(1.98)), p<0.05.
Trabeculectomy resulted in a statistically significant decrease in IOP and increase in ocular blood flow. Effects of trabeculectomy in PXG patients were significantly less than in patients with POAG. Patients with normal APLAs levels had a significant increase in ocular hemodynamics compared to patients with higher APLAs. Further studies are needed to analyze APLAs effects in different patients groups..
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