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P. P. Chen, D. C. Musch, L. M. Niziol, CIGTS Study Group; The Effect of Early Postoperative IOP Spike on Visual Field Progression in the CIGTS. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1590.
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To examine the effect of early postoperative intraocular pressure (IOP) spike on subsequent visual field (VF) loss in 300 subjects undergoing primary trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
CIGTS participants who had an IOP spike of 5 mm Hg or greater above the baseline IOP level on postoperative day 1 were identified, as were those who had no increase in IOP on postoperative day 1 after trabeculectomy. The Mean Deviation (MD) of the Humphrey 24-2 visual field test was compared at 6 months and at years 1, 2, 3, and 5 after enrollment.
Eighteen patients (6%) had an IOP spike of 5 mm Hg or more. Patients with IOP spike were more likely to be African-American (11/18 vs. 91/262, P = .04). Using a generalized linear regression model for predicting VF change from baseline measured continuously, and controlling for baseline VF severity, at each time point examined no associations with postoperative day 1 IOP were found (P = 0.22 or higher). Similar findings were obtained using a logistic regression model for predicting VF change from baseline measured as less than 3 dB vs. 3 dB or more (P = 0.54 or higher). See Table below for t-test comparison of VF MD between groups. Subsequent procedures performed included ALT (5 patients), cataract extraction (4 patients), bleb revision (4 patients), and repeat trabeculectomy (2 patients). A total of 7 patients (39%) underwent further interventions for IOP above target level, which was not significantly different from the cohort without IOP spike.
Clinical Trial: :
www.clinicaltrials.gov nct 00000149
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