June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Rates of Visual Field Change after Trabeculectomy
Author Affiliations & Notes
  • Catherine Baril
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Lesya Shuba
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Paul E Rafuse
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Jayme R Vianna
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Balwantray C Chauhan
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Marcelo T Nicolela
    Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
  • Footnotes
    Commercial Relationships Catherine Baril, None; Lesya Shuba, None; Paul Rafuse, None; Jayme Vianna, None; Balwantray Chauhan, None; Marcelo Nicolela, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2721. doi:
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      Catherine Baril, Lesya Shuba, Paul E Rafuse, Jayme R Vianna, Balwantray C Chauhan, Marcelo T Nicolela; Rates of Visual Field Change after Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2721.

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

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Abstract 
 
Purpose
 

Several recent retrospective studies have evaluated the effect of trabeculectomy on rates of visual field progression before and after surgery. These studies, however, are difficult to interpret as the decision to operate can be triggered by a variety of factors, including a poor visual field test which can cause a regression to the mean and an apparently slower rate of change post-trabeculectomy. We focused on the rate of visual field progression post-trabeculectomy by pairwise matching patients by Mean Deviation (MD) to those who were medically treated.

 
Methods
 

The medical records of all patients who underwent trabeculectomy with mitomycin C by one of two glaucoma specialists (MTN, LMS) were reviewed. We selected patients with ≥ 5 SITA Standard 24-2 visual fields post-trabeculectomy. Eyes with subsequent glaucoma surgery during the follow-up period were excluded. If both eyes were eligible, only one eye was randomly selected. The rate of MD change was calculated for each patient with robust regression with the first post-trabeculectomy field defined as baseline. These patients were then matched by baseline MD with patients treated only medically and followed with ≥5 visual field tests.

 
Results
 

There were 94 patients with median (IQR) age at surgery of 67 (61, 75) years and 8 (6, 9) visual field tests over 5.6 (4.0, 6.8) years post-trabeculectomy. The 94 medically treated matched patients had median age of 69 (61, 77) years and 7 (5, 11) visual field tests over 5.7 (3.9, 9.6) years. The unsigned pairwise difference in baseline median (IQR) MD in the surgically and medically treated groups was 0.01 (0.00, 0.02) dB with a baseline MD of -7.00 (-11.04, -4.30) dB in the surgical group. The median MD slopes were comparable (p = 0.13) between the groups: -0.15 (-0.51, 0.06) dB/y in the surgically treated patients, and -0.07 (-0.42, 0.24) dB/y in the paired medically treated controls.

 
Conclusions
 

Our findings suggest that most patients who undergo trabeculectomy with mitomycin C have relatively slow rates of visual field progression post-operatively. Presumably patients who were treated surgically had a higher risk profile or more progressive disease prior to surgery, but their post-trabeculectomy rate of progression was similar to the rate observed in patients with comparable disease severity who were medically treated.  

 
Rate of progression of mean deviation (dB/y) in surgically treated patients and matched medically treated controls
 
Rate of progression of mean deviation (dB/y) in surgically treated patients and matched medically treated controls

 
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