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Survival of visual function in patients with advanced glaucoma after standard guarded trabeculectomy with MMC

Poster Details

First Author: D.Tsoukanas GREECE

Co Author(s):    A. Salonikiou   M. Zozolou   F. Topouzis   T. Filippopoulos     

Abstract Details

Purpose:

To determine survival of visual function utilizing both visual acuity and perimetric criteria in patients with advanced glaucoma who underwent standard guarded trabeculectomy or combined phacotrabeculectomy at two tertiary glaucoma referral centers.

Setting:

Retrospective, non-comparative, interventional case series. All primary trabeculectomy or phacotrabeculectomy cases with at least -20dB mean deviation (MD) loss on two pre-op consecutive visual field tests operated at tertiary glaucoma referral centers by two glaucoma fellowship trained physicians.

Methods:

Consecutive patients were identified from surgical log books, charts were reviewed and eligible patients were included in the analysis. Primary outcome measures included rates of survival of visual function according to pre-defined criteria: patients not losing 3 lines of Snellen visual acuity, not losing 3 or 1 dB in MD values, not droping below 20/200 in Snellen visual acuity and not being re-operated for glaucoma. Secondary outcome measures included qualified surgical success rates utilizing tube versus trabeculectomy study (TVT) and World Glaucoma Association (WGA) criteria.

Results:

We identified 40 eyes (40 patients) with an average baseline MD of -26.3±4.1dB on perimetry. The average pre-op intraocular pressure (IOP) (26.6±11.3 mmHg) decreased to 11.4±4.0 mmHg (p<0.001) after a mean follow-up of 23.3±15.5 months. We documented preservation of vision by all four combined criteria in a substantial proportion of patients: 77% and 66% at two years if the 3dB or 1 dB criterion was employed respectively. There was a clear seperation in post-op IOP and medication requirements between survivals and non-survivals. Qualified surgical success was estimated as 89% and 78% at 1 and 3 years respectively utilizing TVT criteria.

Conclusions:

Trabeculectomy and/or phacotrabeculectomy allows preservation of visual function and should be recommended in patients with advanced glaucoma not controlled or progressing on maximal medical therapy. Lower IOPs (~10mmHg) maybe beneficial for patients with severe retinal ganglion cell loss in an effort to halt progression of glaucomatous optic neuropathy. FINANCIAL DISCLOUSRE: NONE

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