Ocular pulse amplitude after trabeculectomy

  • Sandra R. von Schulthess
  • Claude Kaufmann
  • Lucas M. Bachmann
  • Ahmet Yanar
  • Michael A. Thiel
Clinical Investigation



The ocular pulse amplitude (OPA) is the difference between the minimum and maximum values of the pulsatile intraocular pressure (IOP) wave contour. The OPA depends on ocular perfusion and IOP, which are both affected by a trabeculectomy (TE). The aim of this study was to investigate how the OPA changes after TE and whether an early change in OPA can be used as a prognostic marker for a successful long-term outcome.


Fourteen consecutive patients (26–84 years old) with medically uncontrolled primary open-angle or pseudoexfoliation glaucoma were included in the study. IOP and OPA were measured with a dynamic contour tonometer before and after TE on days –1, +1, +7, +14, +21, +28, +42, +56, +70, and +84. The OPA of the contralateral eye was used to control for variations in systemic haemodynamics. TE was regarded as successful if a persistent drop in IOP of at least 20% without the use of IOP-lowering treatment was achieved. Data were analysed using receiver operating characteristic curves, Kaplan–Meier survival curves and Mann–Whitney two-sample analysis.


Five out of 14 TEs had an entirely successful outcome. The other 9 patients required additional interventions such as suturolysis, needling of subconjunctival scar tissue and antimetabolite injections during the 3-month period after the TE. On the first day after surgery, OPA decreased in 12 patients and increased in 2 patients compared with the preoperative measurements. In the 5 patients with a successful long-term outcome, OPA dropped by 3.38±1.79 mmHg (mean±SE), whereas the initial OPA drop in those cases that required additional interventions was 0.62+/−1.81 mmHg only (p<0.01). IOP dropped by 13.10±2.14 mmHg in the successful group and by 5.84±2.51 mmHg in the unsuccessful group (p=0.19). Kaplan-Meier estimates of survival showed that patients with an initial OPA drop of more than 2.0 mmHg had a significantly better chance of an entirely uncomplicated 3-month outcome after TE than patients with an initial OPA drop of less than 2.0 mmHg (log rank p<0.01).


This pilot study indicates that an early drop in OPA of more than 2.0 mmHg after TE may be a good prognostic parameter for successful long-term control of IOP.


Ocular Pulse Amplitude Dynamic Contour Tonometry Pseudoexfoliation Glaucoma Dexamethasone Phosphate Dynamic Contour Tonometer 
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  1. 1.
    Ajubi NE, Klein-Nulend J, Nijweide PJ, Vrijheid-Lammers T, Alblas MJ, Burger EH (1996) Pulsating fluid flow increases prostaglandin production by cultured chicken osteocytes—a cytoskeleton-dependent process. Biochem Biophys Res Commun 225:62–68CrossRefPubMedGoogle Scholar
  2. 2.
    Cantor LB (2001) The effect of trabeculectomy on ocular hemodynamics. Trans Am Ophthalmol Soc 99:241–252PubMedGoogle Scholar
  3. 3.
    Flammer J, Orgul S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, Renard JP, Stefansson E (2002) The impact of ocular blood flow in glaucoma. Prog Retin Eye Res 21:359–393CrossRefPubMedGoogle Scholar
  4. 4.
    Francis BA, Wang M, Lei H, Du LT, Minckler DS, Green RL, Roland C (2005) Changes in axial length following trabeculectomy and glaucoma drainage device surgery. Br J Ophthalmol 89:17–20CrossRefPubMedGoogle Scholar
  5. 5.
    Fujikura H, Seko Y, Tokoro T, Mochizuki M, Shimokawa H (2002) Involvement of mechanical stretch in the gelatinolytic activity of the fibrous sclera of chicks, in vitro. Jpn J Ophthalmol 46:24–30CrossRefPubMedGoogle Scholar
  6. 6.
    Gekkieva M, Orgul S, Gherghel D, Gugleta K, Prunte C, Flammer J (2001) The influence of sex difference in measurements with the Langham Ocular Blood Flow System. Jpn J Ophthalmol 45:528–532CrossRefPubMedGoogle Scholar
  7. 7.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMedGoogle Scholar
  8. 8.
    James CB (1994) Effect of trabeculectomy on pulsatile ocular blood flow. Br J Ophthalmol 78:818–822PubMedCrossRefGoogle Scholar
  9. 9.
    James CB, Trew DR, Clark K, Smith SE (1991) Factors influencing the ocular pulse–axial length. Graefes Arch Clin Exp Ophthalmol 229:341–344CrossRefPubMedGoogle Scholar
  10. 10.
    Kaufmann C, Bachmann LM, Thiel MA (2004) Comparison of dynamic contour tonometry with Goldmann applanation tonometry. Invest Ophthalmol Vis Sci 45:3118–3121CrossRefPubMedGoogle Scholar
  11. 11.
    Kniestedt C, Nee M, Stamper RL (2004) Dynamic contour tonometry: a comparative study on human cadaver eyes. Arch Ophthalmol 122:1287–1293CrossRefPubMedGoogle Scholar
  12. 12.
    Krakau CET (1992) Calculation of the pulsatile ocular blood flow. Invest Ophthalmol Vis Sci 33:2754–2756PubMedGoogle Scholar
  13. 13.
    Marquardt D, Lieb WE, Grehn F (2004) Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies. Graefes Arch Clin Exp Ophthalmol 242:106–113CrossRefPubMedGoogle Scholar
  14. 14.
    Perkins ES (1981) The ocular pulse. Curr Eye Res 1:19–23PubMedCrossRefGoogle Scholar
  15. 15.
    Poinoosawmy D, Indar A, Bunce C, Garway-Heath DF, Hitchings RA (2002) Effect of treatment by medicine or surgery on intraocular pressure and pulsatile ocular blood flow in normal-pressure glaucoma. Graefes Arch Clin Exp Ophthalmol 240:721–726PubMedCrossRefGoogle Scholar
  16. 16.
    Schmidt KG, Dick B, von Ruckmann A, Pillunat LE (1997) Ocular pulse amplitude and local carbonic anhydrase inhibition. Ophthalmologe 94:659–664CrossRefPubMedGoogle Scholar
  17. 17.
    Silver DM, Geyer O (2000) Pressure-volume relation for the living human eye. Curr Eye Res 20:115–120CrossRefPubMedGoogle Scholar
  18. 18.
    Trew DR, James CB, Thomas SH, Sutton R, Smith SE (1991) Factors influencing the ocular pulse–the heart rate. Graefes Arch Clin Exp Ophthalmol 229:553–556CrossRefPubMedGoogle Scholar
  19. 19.
    Wegner W (1930) Neue Ergebnisse ueber die pulsatorischen Schwankungen des menschlichen Bulbus und seiner Huellen. Arch Augenheilkd 102:1–32Google Scholar
  20. 20.
    Yang YC, Hulbert MF (1995) Effect of trabeculectomy on pulsatile ocular blood flow. Br J Ophthalmol 79:507–508PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Sandra R. von Schulthess
    • 1
  • Claude Kaufmann
    • 1
  • Lucas M. Bachmann
    • 2
  • Ahmet Yanar
    • 1
  • Michael A. Thiel
    • 1
  1. 1.Department of OphthalmologyUniversity of ZurichZurichSwitzerland
  2. 2.Horten CentreUniversity of ZurichZurichSwitzerland

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