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Improved retinal function after trabeculectomy in glaucoma patients

  • Retinal Disorders
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Abstract

Purpose

To investigate retinal function after reduction of intraocular pressure (IOP) by filtration surgery in patients with medically uncontrolled glaucoma.

Methods

Eleven patients (11 eyes) with medically uncontrolled glaucoma underwent trabeculectomy. Clinical investigation, visual field (testing with standard automated perimetry (SAP–Humphrey), optical coherence tomography (OCT), full-field electroretinography (full-field ERG) and multifocal electroretinography (mfERG) were performed preoperatively as well as 2 and 6 months after surgery.

Design

Interventional prospective, consecutive case series.

Results

No significant reduction was seen in mean log MAR visual acuity 2 or 6 months after filtration surgery. The mean preoperative intraocular pressure of 27.1 (±6.2) mmHg decreased to 19.0(±6.1) mmHg 2 months after surgery and to 17.1 (± 3.4) mmHg 6 months after surgery (both p = 0.001). The reduction in IOP significantly decreased the number of anti-glaucoma agents used, from 3.7 ± 1.6 at baseline to 0.8 ± 0.9 2 months after surgery and to 1.3 ± 1.2 6 months after surgery (p = 0.004 and p = 0.008 respectively). The results of SAP, OCT and full-field ERG did not show any significant difference between pre- and postoperative values at any point in time. No significant improvement was found with regard to the first positive peak (P1) amplitudes in the macular retina (area 1) or in the perimacular retina/periphery (area 2) when measured with mfERG 2 months after surgery. The mfERG examinations revealed significantly improved P1 amplitudes 6 months after surgery in both area 1 and area 2, compared with the preoperative values (p = 0.042 and p = 0.014 respectively). The implicit time of P1 decreased significantly 6 months after surgery in area 2 compared with the preoperative values (p = 0.023).

Conclusion

A significant lowering of IOP seems to improve the function of the central retina, as demonstrated by increased amplitudes and reduced implicit times assessed with mfERG.

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Acknowledgements

We would like to thank Ing-Marie Holst and Boel Nilsson for their skilful technical assistance. This study was supported by “Stiftelsen för synskadade i f.d. Malmöhus län” (The foundation for the visually impaired in the former county of Malmöhus), and grants from the Swedish Medical Research Council and the Foundation Fighting Blindness, Owings Mills, Maryland, USA.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Lund, SE-221 85, Lund, Sweden

    Elisabeth Wittström, Patrik Schatz, Monica Lövestam-Adrian, Vesna Ponjavic, Anders Bergström & Sten Andréasson

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  1. Elisabeth Wittström
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  2. Patrik Schatz
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Correspondence to Elisabeth Wittström.

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Wittström, E., Schatz, P., Lövestam-Adrian, M. et al. Improved retinal function after trabeculectomy in glaucoma patients. Graefes Arch Clin Exp Ophthalmol 248, 485–495 (2010). https://doi.org/10.1007/s00417-009-1220-5

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