Trabeculectomy for advanced glaucoma

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Abstract
The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13–80 years). The mean follow-up time was 41.1 months (3–120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was −24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (−23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.