Trabeculectomy outcomes for patients with advanced glaucoma

Abstract

Context Safety and cost-effectiveness of trabeculectomy in advanced glaucoma is essential. Aim The aim was to evaluate the visual outcome and visual field (VF) changes in patients with advanced glaucoma who underwent trabeculectomy. Settings and design The study was done on 36 eyes clinically diagnosed with advanced primary open-angle glaucoma (POAG) who were uncontrolled on medical treatment and had cup-to-disc ratio (CDR) of more than 0.85 along with severe glaucomatous VF defects. The visual outcome changes were evaluated after 1 week, 1 month, and 3 months following trabeculectomy, whereas VF changes were evaluated at 3 months after trabeculectomy. Participants and methods Full preoperative and postoperative ophthalmological examination, including number of antiglaucoma medications, assessment of best-corrected visual acuity, intraocular pressure (IOP), gonioscopy, slit lamp biomicroscopy, and detailed fundus examination, was performed. Statistical analysis SPSS statistical software, version 21, was used for statistical analysis. Normality of the data was tested by Shapiro–Wilk test, as the study had non-normally distributed variables (P < 0.05). Analysis was done using Friedman test, and post-hoc test was further evaluated by Wilcoxon signed-rank test. Spearman correlation coefficient was computed to assess the relationship between the percentage change in IOP and the change in best-corrected visual acuity. Results Records of 36 eyes (17 right and 19 left) of 30 patients (14 males and 24 females) with advanced-POAG were reviewed. Median age of patients was 65.50 (43–74) years. Median preoperative VA was 0.48 (0.3–0.78), and after surgery, it improved significantly to 0.6 (0.35–0.78) (P = 0.000). Median preoperative IOP was 22.50 (20–25) mmHg on maximum tolerated medications, ranging 16–38, which declined significantly to 15 (13–17.75) mmHg, ranging 7–32, postoperatively (P = 0.000). Preoperative fundus examination showed vertical-CDR of 0.85–1, with median of 0.9 (0.9–0.95), which did not change after surgery (P = 0.436). Median of the number of preoperative antiglaucoma medications was 3, ranging 1–4, decreasing to zero medications, ranging 0–2 postoperatively (P = 0.000). Conclusion IOP control, decreasing number of medications, and VA improvement are the main outcomes of trabeculectomy in patients with advanced POAG. This is associated with a better quality of life in those patients as the CDR did not change.

Keywords

• advanced glaucoma
• intraocular pressure
• trabeculectomy