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Qian Liu, Murtaza Saifee, Yinxi Yu, Gui-Shuang Ying, Ying Han; Evaluation of Long-Term Visual Field Function in Patients Undergoing Glaucoma Drainage Device Implantation. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3888.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine the change in global and regional Humphrey visual field (VF) after glaucoma drainage device (GDD) implantation in glaucomatous eyes over 3-year follow-up.
Methods: Patients undergoing placement of an Ahmed, Baerveldt, or Molteno implant from 2010-2015 at the University of California, San Francisco. Patients who underwent GDD placement with reliable pre-operative and yearly post-operative VF measurements were included in this study. Clinical parameters were compared between pre-operative and follow-up visits, including visual acuity, intraocular pressure (IOP), number of glaucoma medications, global VF metrics (mean deviation (MD), pattern standard deviation (PSD), Collaborative Initial Glaucoma Treatment Study (CIGTS) score on total deviation probability (CIGTS_TDP) and pattern deviation probability (CIGTS_PDP)), and regional metrics (regional total deviation (TD), regional pattern deviation (PD), and regional CIGTS_TDP and CIGTS_PDP). Univariate and multivariate regression analyses were performed to determine risk factors for VF worsening after GDD implantation surgery.
Results: A total of 106 eyes from 95 patients were included in the study with an age (mean ± standard deviation) of 65.9±15.9 years. Sixty-seven (63.2%) eyes were pseudophakic at presentation. IOP (mean±standard deviation) was reduced from 23.1±8.5 mmHg to 12.7±3.1 mmHg at 3-year follow-up (P<0.001). Mean preoperative MD, PSD, CIGTS_TDP and CIGTS_PDP were -11.7±7.8 dB, 7.8±3.8, 12.8±6.2 and 8.2±6.0, respectively. MD, PSD and global CIGTS_PDP showed no statistically significant changes in follow-up, whereas global CIGTS_TDP showed mild progression from 10.7 to 12.8 at 3-year follow-up (p = 0.01). No regional metrics showed worsening in follow-up. Defects in the superior hemifield was more common than in inferior hemifield at baseline and follow-ups for all regional metrics. Pre-operative number of glaucoma medications was found to be associated with worsening on CIGTS_TDP.
Conclusion: Overall, GDD implantation surgery is effective at reducing IOP and stabilizing VF function in glaucomatous eyes over 3-years of follow-up. The superior hemifield is affected more severely compared to the other regions. The number of pre-operative glaucoma medications is associated with mild VF progression measured by CIGTS_TDP.
This is a 2020 ARVO Annual Meeting abstract.
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