Abstract
Purpose :
Intraocular pressure (IOP) reduction is the only known treatment option with proven efficacy to decelerate disease progression in glaucoma. Clinically glaucoma can be monitored by means of functional tests (visual field testing by standard automated perimetry (SAP)) and / or anatomical measurements (monitoring of retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT)). The aim of this analysis was to monitor SAP and RNFL thickness during the post-surgical course after trabeculectomy (TE) and deep sclerectomy (DS).
Methods :
All eyes undergoing TE or DS between 2010 and 2020 for the treatment of primary open-angle glaucoma at the university eye hospital in Bern, Switzerland were included and analyzed when a post-surgical follow-up of at least 2 years with regular SAP and OCT follow-up measurements was present. IOP, number of IOP-lowering medications as well as results for SAP and RNFL thickness measurements were analyzed.
Results :
TE was performed in 108 patients (54 female, 54 male) with a mean age of 64.18±15.88 years. DS was performed in 183 patients (101 female, 82 male) with a mean age of 68.94±11.39 years. Mean IOP decreased from 23.71±0.86 and 23.75±0.79 mmHg to 12.51±0.57 (p<0.001; compared to baseline) and 14.08±0.87 mmHg (p<0.001; compared to baseline), while mean number of applied IOP-lowering medication decreased from 3.41±0.11 and 3.27±0.11 to 0.57±0.11 (p<0.001) and 1.08±0.18 (p<0.001) in the respective TE and DS groups during 2 years of follow-up. During follow-up mean peripapillary RNFL thickness decreased from 64.58±1.97 and 63.59±6.04 µm to 57.81±1.94 (p<0.001) and 58.31±8.69 µm (p=0.005) in the TE and DS groups. Mean defect of SAP remained stable with -11.62±0.66 and -10.59±0.95 dB at baseline and -11.67±0.63 (p=0.82) and -10.95±1.18 dB (p=0.64) 2 years after surgery in the respective TE and DS groups.
Conclusions :
TE and DS are effective in reducing IOP and number of IOP-lowering medication. However, while visual field defects seem to remain stable, peripapillary RNFL thickness as measured using OCT further decreases.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.