Abstract
Purpose :
To investigate the visual acuity (VA) changes that occur after trabeculectomy (TLE) and related factors to their recovery in cases with advanced glaucoma
Methods :
One hundred one eyes of 101 patients after initial TLE procedure fulfilling the following conditions were included in this retrospective study: 1) patients with a postoperative follow-up of at least 1 year; 2) patients with reliable results of Humphry visual field program central 30-2 (VF) and patients with preoperative mean deviation (MD) < -12 dB. VA and intraocular pressure (IOP) changes after TLE and factors affecting postoperative VA were investigated. The deterioration of VA at 1 year was defined as reduction of more than 3 lines of Snellen VA. Logistic regression analysis (LRA) was used to determine explanatory variable independently associated with VA deterioration.
Results :
The average of MD was -18.89 ± 5.03 dB. The mean preoperative IOP and numbers of medications decreased significantly from 20.6 mmHg and 4.8 to 10.5 mmHg and 0.7 at 1 year, respectively (ANOVA, P < 0.01). The mean corrected VA for all patients was 0.12 ± 0.34, which once deteriorated and showed a significant decrease up to 6 months postoperatively, but recovered to a non-significant level at 1 year. The significant differences in clinical factors between 8 cases with VA deterioration at 1 year and 93 cases were pre-massage IOP at postoperative day 1 (19.1 vs 14.0 mmHg), 2 weeks (11.6 vs 8.7 mmHg), and 6 months (13.1 vs 10.4 mmHg), mean IOP during 1 year (12.8 vs. 10.3 mmHg) (Wilcoxon signed rank test, all P values < 0.01), and medications at 1 year (P = 0.03). Choroidal detachment and hypotony were occurred in 0 and 16 cases, respectively (P = 0.23). Other preoperative factors including age, diagnosis, axial length, central corneal thickness, refraction, VA, IOP, medications, MDs, foveal thresholds and average MD of 4 central points of VF were not significantly different. Among explanatory variable including preoperative and postoperative factors, and complications, LRA detected that mean IOP during 1 year were significantly associated with cases of VA deterioration at 1 year (odds ratio =1.90, P = 0.01).
Conclusions :
In advanced glaucoma, it takes more than 6 months for VA to recover after TLE. However, 8.6 % did not recover after1 year, which may be related to the lack of tight control of IOP rather than complications.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.