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Susanna Koenig, Giovanni Montesano, Clarissa Fang, David P. Crabb, Hari Jayaram, Jonathan Clarke; Effect of trabeculectomy on the rate of progression of visual field damage. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3374.
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To quantify the effect of trabeculectomy on the rate of progression (RoP) of visual field (VF) damage.
Clinical and VF data from 199 patients that were randomly selected from the cohort of patients that underwent trabeculectomy between 2015 and 2016 were extracted from clinical charts and digital archives at the network of sites of Moorfields Eye Hospital NHS Foundation Trust. Of these, we selected 80 patients who met our criteria of at least three reliable VFs before and after surgery. Reliability was defined by a false positive rate < 15%. The change in RoP was tested using total deviation (TD) values through a mixed effect model with random effects on both intercepts and slopes. The fixed effects modelled a broken-stick regression of TD over time, with a breakpoint at the day of surgery. We used two nested levels of random effects (patient and location within the VF, example in Figure 1). The fixed effect component of the model provided an estimate of the average change in slope between the pre and post-operative period.
We analysed 10 [9, 12] VFs per subject (Median [Interquartile Range]). At surgery, the age was 67 [57, 72] years, the mean deviation was -10.84 [-14.68, -5.56] dB and the intraocular pressure (IOP) was 18 [15, 20] mmHg. One year after surgery, the IOP was 10 [8, 13] mmHg (p = 0.002). The mean RoP before surgery was -0.82 [-0.58, -1.07] dB/year (Mean [95% Confidence Intervals]) and it was slowed down by 0.56 [0.23, 0.89] dB/year (p = 0.001, Figure 2) after surgery.
Glaucoma patients who underwent trabeculectomy in 2015/16 showed a significant reduction in the rate of progression of the visual fields postoperatively throughout their follow-up.
This is a 2021 ARVO Annual Meeting abstract.
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