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Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity

  • Glaucoma
  • Published:
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Abstract

Purpose

To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery.

Method

Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated.

Results

The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05).

Conclusion

The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

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References

  1. Norskov K (1970) Routine tonometry in ophthalmic practice. II five-year follow-up Acta Ophthalmol (Copenh) 48:873–895. https://doi.org/10.1111/j.1755-3768.1970.tb08208.x

    Article  CAS  PubMed  Google Scholar 

  2. Perkins ES (1973) The Bedford glaucoma survey. I. long-term follow-up of borderline cases. Br J Ophthalmol 57:179–185. https://doi.org/10.1136/bjo.57.3.179

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kitazawa Y, Horie T, Aoki S, Suzuki M, Nishioka K (1977) Untreated ocular hypertension. a long-term prospective study. Arch Ophthalmol 95:1180–1184. https://doi.org/10.1001/archopht.1977.04450070078004

    Article  CAS  PubMed  Google Scholar 

  4. Lundberg L, Wettrell K, Linner E (1987) Ocular hypertension. a prospective twenty-year follow-up study. Acta Ophthalmol (Copenh) 65:705–708. https://doi.org/10.1111/j.1755-3768.1987.tb07067.x

    Article  CAS  PubMed  Google Scholar 

  5. Armaly MF, Krueger DE, Maunder L, Becker B, Hetherington J Jr, Kolker AE, Levene RZ, Maumenee AE, Pollack IP, Shaffer RN (1980) Biostatistical analysis of the collaborative glaucoma study. I. summary report of the risk factors for glaucomatous visual-field defects. Arch Ophthalmol 98:2163–2171. https://doi.org/10.1001/archopht.1980.01020041015002

    Article  CAS  PubMed  Google Scholar 

  6. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial G (2002) Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol 120:1268–1279. https://doi.org/10.1001/archopht.120.10.1268

    Article  PubMed  Google Scholar 

  7. Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA, Mills RP, Group CS (2001) Interim clinical outcomes in the collaborative initial glaucoma treatment study comparing initial treatment randomized to medications or surgery. Ophthalmology 108:1943–1953. https://doi.org/10.1016/s0161-6420(01)00873-9

    Article  CAS  PubMed  Google Scholar 

  8. Collaborative Normal-Tension Glaucoma Study Group (1998) Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 126:487–497. https://doi.org/10.1016/s0002-9394(98)00223-2

    Article  Google Scholar 

  9. AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration.the AGIS investigators. Am J Ophthalmol 130:429–440. https://doi.org/10.1016/s0002-9394(00)00538-9

    Article  Google Scholar 

  10. Epstein DL, Krug JH Jr, Hertzmark E, Remis LL, Edelstein DJ (1989) A long-term clinical trial of timolol therapy versus no treatment in the management of glaucoma suspects. Ophthalmology 96:1460–1467. https://doi.org/10.1016/s0161-6420(89)32688-1

    Article  CAS  PubMed  Google Scholar 

  11. Kass MA, Gordon MO, Hoff MR, Parkinson JM, Kolker AE, Hart WM Jr, Becker B (1989) Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. a randomized, double-masked, long-term clinical trial. Arch Ophthalmol 107:1590–1598. https://doi.org/10.1001/archopht.1989.01070020668025

    Article  CAS  PubMed  Google Scholar 

  12. Schulzer M, Drance SM, Douglas GR (1991) A comparison of treated and untreated glaucoma suspects. Ophthalmology 98:301–307. https://doi.org/10.1016/s0161-6420(91)32296-6

    Article  CAS  PubMed  Google Scholar 

  13. Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL (2007) Utilization of various glaucoma surgeries and procedures in medicare beneficiaries from 1995 to 2004. Ophthalmology 114:2265–2270. https://doi.org/10.1016/j.ophtha.2007.02.005

    Article  PubMed  Google Scholar 

  14. Robin AL, Ramakrishnan R, Krishnadas R, Smith SD, Katz JD, Selvaraj S, Skuta GL, Bhatnagar R (1997) A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol 115:969–974. https://doi.org/10.1001/archopht.1997.01100160139001

    Article  CAS  PubMed  Google Scholar 

  15. Khaw P, Wilkins M (1999) Antifibrotic agents in glaucoma surgery. In: Yanoff M, Duker J (eds) Ophthalmology. Churchill Livingstone, London, pp 1–88

    Google Scholar 

  16. Aggarwal SP, Hendeles S (1986) Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol 70:97–99. https://doi.org/10.1136/bjo.70.2.97

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Martinez JA, Brown RH, Lynch MG, Caplan MB (1993) Risk of postoperative visual loss in advanced glaucoma. Am J Ophthalmol 115:332–337. https://doi.org/10.1016/s0002-9394(14)73584-6

    Article  CAS  PubMed  Google Scholar 

  18. Topouzis F, Tranos P, Koskosas A, Pappas T, Anastasopoulos E, Dimitrakos S, Wilson MR (2005) Risk of sudden visual loss following filtration surgery in end-stage glaucoma. Am J Ophthalmol 140:661–666. https://doi.org/10.1016/j.ajo.2005.04.016

    Article  PubMed  Google Scholar 

  19. Langerhorst CT, de Clercq B, van den Berg TJ (1990) Visual field behavior after intra-ocular surgery in glaucoma patients with advanced defects. Doc Ophthalmol 75:281–289. https://doi.org/10.1007/BF00164842

    Article  CAS  PubMed  Google Scholar 

  20. Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B (1993) Loss of visual acuity after trabeculectomy. Ophthalmology 100:599–612. https://doi.org/10.1016/s0161-6420(93)31597-6

    Article  CAS  PubMed  Google Scholar 

  21. Law SK, Nguyen AM, Coleman AL, Caprioli J (2007) Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol 125:1044–1050. https://doi.org/10.1001/archopht.125.8.1044

    Article  PubMed  Google Scholar 

  22. Francis BA, Hong B, Winarko J, Kawji S, Dustin L, Chopra V (2011) Vision loss and recovery after trabeculectomy: risk and associated risk factors. Arch Ophthalmol 129:1011–1017. https://doi.org/10.1001/archophthalmol.2011.182

    Article  PubMed  Google Scholar 

  23. Kobayashi N, Hirooka K, Nitta E, Ukegawa K, Tsujikawa A (2018) Visual acuity and corneal higher-order aberrations after EX-PRESS or trabeculectomy, and the determination of associated factors that influence visual function. Int Ophthalmol 38:1969–1976. https://doi.org/10.1007/s10792-017-0685-1

    Article  PubMed  Google Scholar 

  24. Sugiyama T, Shibata M, Kojima S, Ueki M, Ikeda T (2011) The first report on intermediate-term outcome of Ex-PRESS glaucoma filtration device implanted under scleral flap in Japanese patients. Clin Ophthalmol 5:1063–1066. https://doi.org/10.2147/OPTH.S23129

    Article  PubMed  PubMed Central  Google Scholar 

  25. Beltran-Agullo L, Trope GE, Jin Y, Wagschal LD, Jinapriya D, Buys YM (2015) Comparison of visual recovery following EX-PRESS versus trabeculectomy: results of a prospective randomized controlled trial. J Glaucoma 24:181–186. https://doi.org/10.1097/IJG.0b013e31829e1b68

    Article  PubMed  Google Scholar 

  26. Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y, Araie M, Collaborative Bleb-Related Infection I, Treatment Study G (2016) Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol 94:e561–e570. https://doi.org/10.1111/aos.13058

    Article  CAS  PubMed  Google Scholar 

  27. Kolker AE (1977) Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 75:539–555

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Edmunds B, Thompson JR, Salmon JF, Wormald RP (2002) The national survey of trabeculectomy. III early and late complications Eye (Lond) 16:297–303. https://doi.org/10.1038/sj.eye.6700148

    Article  CAS  PubMed  Google Scholar 

  29. Altan C, Ozturker C, Bayraktar S, Eren H, Ozturker ZK, Yilmaz OF (2008) Post-trabeculectomy choroidal detachment: not an adverse prognostic sign for either visual acuity or surgical success. Eur J Ophthalmol 18:771–777. https://doi.org/10.1177/112067210801800518

    Article  CAS  PubMed  Google Scholar 

  30. Takihara Y, Inatani M, Seto T, Iwao K, Iwao M, Inoue T, Kasaoka N, Murakami A, Futa R, Tanihara H (2011) Trabeculectomy with mitomycin for open-angle glaucoma in phakic vs pseudophakic eyes after phacoemulsification. Arch Ophthalmol 129:152–157. https://doi.org/10.1001/archophthalmol.2010.348

    Article  PubMed  Google Scholar 

  31. Kim BS, Savinova OV, Reedy MV, Martin J, Lun Y, Gan L, Smith RS, Tomarev SI, John SW, Johnson RL (2001) Targeted disruption of the myocilin gene (Myoc) suggests that human glaucoma-causing mutations are gain of function. Mol Cell Biol 21:7707–7713. https://doi.org/10.1128/MCB.21.22.7707-7713.2001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gould DB, Miceli-Libby L, Savinova OV, Torrado M, Tomarev SI, Smith RS, John SW (2004) Genetically increasing Myoc expression supports a necessary pathologic role of abnormal proteins in glaucoma. Mol Cell Biol 24:9019–9025. https://doi.org/10.1128/MCB.24.20.9019-9025.2004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kwon YH, Fingert JH, Kuehn MH, Alward WL (2009) Primary open-angle glaucoma. N Engl J Med 360:1113–1124. https://doi.org/10.1056/NEJMra0804630

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Liu Y, Allingham RR (2017) Major review: molecular genetics of primary open-angle glaucoma. Exp Eye Res 160:62–84. https://doi.org/10.1016/j.exer.2017.05.002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Rezaie T, Child A, Hitchings R, Brice G, Miller L, Coca-Prados M, Heon E, Krupin T, Ritch R, Kreutzer D, Crick RP, Sarfarazi M (2002) Adult-onset primary open-angle glaucoma caused by mutations in optineurin. Science 295:1077–1079. https://doi.org/10.1126/science.1066901

    Article  CAS  PubMed  Google Scholar 

  36. Ariani F, Longo I, Frezzotti P, Pescucci C, Mari F, Caporossi A, Frezzotti R, Renieri A (2006) Optineurin gene is not involved in the common high-tension form of primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 244:1077–1082. https://doi.org/10.1007/s00417-005-0079-3

    Article  CAS  PubMed  Google Scholar 

  37. Charlesworth JC, Stankovich JM, Mackey DA, Craig JE, Haybittel M, Westmore RN, Sale MM (2006) Confirmation of the adult-onset primary open angle glaucoma locus GLC1B at 2cen-q13 in an Australian family. Ophthalmologica 220:23–30. https://doi.org/10.1159/000089271

    Article  PubMed  Google Scholar 

  38. Hauser MA, Sena DF, Flor J, Walter J, Auguste J, Larocque-Abramson K, Graham F, Delbono E, Haines JL, Pericak-Vance MA, Rand Allingham R, Wiggs JL (2006) Distribution of optineurin sequence variations in an ethnically diverse population of low-tension glaucoma patients from the United States. J Glaucoma 15:358–363. https://doi.org/10.1097/01.ijg.0000212255.17950.42

    Article  PubMed  Google Scholar 

  39. Ritch R, Schlotzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315. https://doi.org/10.1016/s0039-6257(00)00196-x

    Article  CAS  PubMed  Google Scholar 

  40. Aboobakar IF, Johnson WM, Stamer WD, Hauser MA, Allingham RR (2017) Major review: exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology. Exp Eye Res 154:88–103. https://doi.org/10.1016/j.exer.2016.11.011

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan

    Nobuyuki Sato, Masayuki Kasahara, Yusuke Kono, Kazunori Hirasawa & Nobuyuki Shoji

Authors
  1. Nobuyuki Sato
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  2. Masayuki Kasahara
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  3. Yusuke Kono
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  4. Kazunori Hirasawa
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Contributions

Nobuyuki Sato; designed the study and performed the experiments, collected data, wrote the manuscript.

Masayuki Kasahara; collected data, provided and cared for study patients.

Yusuke Kono; collected data, provided and cared for study patients.

Kazunori Hirasawa; served as scientific advisor.

Nobuyuki Shoji; critically reviewed the study proposal, wrote and edited the manuscript.

Corresponding author

Correspondence to Nobuyuki Shoji.

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All research procedures followed the Declaration of Helsinki. This study was approved by the Kitasato University Hospital Ethics Committee.

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Sato, N., Kasahara, M., Kono, Y. et al. Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity. Graefes Arch Clin Exp Ophthalmol 261, 2611–2623 (2023). https://doi.org/10.1007/s00417-023-06076-3

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  • DOI: https://doi.org/10.1007/s00417-023-06076-3

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