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Surgical Management of Normal Tension Glaucoma

  • Sarah S. KhodadadehEmail author
  • James C. Tsai
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

Normal tension glaucoma is a progressive optic neuropathy that poses technical complexity in management to prevent vision loss. Surgical intervention is necessary when visual field progression is noted or imminent. Trabeculectomy with adjunct use of the anti-scarring agent mitomycin-C is the treatment of choice in achieving a target intraocular pressure to preserve vision in normal tension glaucoma patients. This subset of patients is at a relatively higher risk for dense visual field defects and postoperative surgical management is key to success for the patient and the surgeon. Other surgical interventions can be of aid in combination with each other or with traditional trabeculectomy and antimetabolite treatment to prevent fibrosis; however, these surgeries have not definitively resulted in intraocular pressures low enough to reach a desired target in normal tension glaucoma patients.

Keywords

Normal tension glaucoma Low-tension glaucoma Glaucoma Intraocular pressure Surgery 

Notes

Acknowledgments

Conflict of interest: None to disclose

Compliance and ethical requirements: No animal or human studies were carried out by the authors for this article.

Compliance with ethical requirements: Dr. Khodadadeh and Dr. Tsai declare that they have no conflict of interest. No animal or human studies were carried out by the authors for this article.

Supplementary material

Video 10.1

Trabeculectomy with adjunctive Mitomycin-C; Sarah Khodadadeh, MD and James C. Tsai, MD, MBA (MV4 89,683 kb)

References

  1. 1.
    Lee BL, Bathija R, Weinreb RN. The definition of normal-tension glaucoma. J Glaucoma. 1998;7(6):366–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Leske MC. Open-angle glaucoma-an epidemiologic overview (review). Ophthalmic Epidemiol. 2007;14(4):166–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Cedrone C, Mancino R, Cerulli A, et al. Epidemiology of primary glaucoma: prevalence, incidence, and blinding effects (review). Prog Brain Res. 2008;173:3–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Shiose Y, Kitazawa Y, Tsukahara S, et al. Epidemiology of glaucoma in Japan—a nationwide glaucoma survey. Jpn J Ophthalmol. 1991;35(2):133–55.PubMedGoogle Scholar
  5. 5.
    Drance SM, Sweeney VP, Morgan RW, et al. Studies of factors involved in the production of low tension glaucoma. Arch Ophthalmol. 1973;89(6):457–65.CrossRefPubMedGoogle Scholar
  6. 6.
    Drance SM, Morgan RW, Sweeney VP. Shock-induced optic neuropathy: a cause of nonprogressive glaucoma. N Engl J Med. 1973;288(8):393–5.CrossRefGoogle Scholar
  7. 7.
    Shields MB. Normal-tension glaucoma: is it different from primary open-angle glaucoma? Curr Opin Ophthalmol. 1991;19(2):85–8.CrossRefGoogle Scholar
  8. 8.
    Allingham RR, Damji KF, Freedman S, Moroi SE, Shafranov G, editors. Chronic open-angle glaucoma and normal-tension glaucoma. In: Shields’ textbook of glaucoma. 5th ed. Philadelphia: Lippincott Williams &Wilkins, 2005. p. 176–88.Google Scholar
  9. 9.
    Allingham RR, Damji KF, Freedman S, Moroi SE, Shafranov G, editors. Surgery of the anterior chamber angle and iris. In: Shields’ textbook of glaucoma, 5th ed. 2005: Lippincott Williams &Wilkins, Philadelphia. p. 452–9.Google Scholar
  10. 10.
    Allingham RR, Damji KF, Freedman S, Moroi SE, Shafranov G, editors. Management of glaucoma. In: Shields’ textbook of glaucoma, 5th ed. Philadelphia: Lippincott Williams &Wilkins, 2005. p. 483–523.Google Scholar
  11. 11.
    Francis BA, Hong B, Winarko J, et al. Vision loss and recovery after trabeculectomy: risk and associated risk factors. Arch Ophthalmol. 2011;129(8):1011–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Kolker AE. 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. 1977;75:539–55.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Heijl A, Peters D, Leske MC, Bengtsson B. Effects of argon laser trabeculoplasty in the Early Manifest Glaucoma Trial. Am J Ophthalmol. 2011;152(2):842–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Schuman JS. Effects of systemic beta-blocker therapy on the efficacy and safety of topical brimonidine and timolol. Brimonidine Study Groups 1 and 2. Ophthalmology. 2000;108(6):1171–7.CrossRefGoogle Scholar
  15. 15.
    Pfeiffer N, Lamparter J, Gericke A, et al. Neuroprotection of medical IOP-lowering therapy. Cell Tissue Res. 2013;353(2):245–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Collaborative Normal-Tension Glaucoma Study (CNTGS) Group. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998;126(4):487–505.CrossRefGoogle Scholar
  17. 17.
    Kim M, Kim DM, Park KH, Kim TW, Jeoung JW, Kim SH. Intraocular pressure reduction with topical medications and progression of normal-tension glaucoma: a 12-year mean follow-up study. Acta Ophthalmol. 2013;91(4):e270–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Klink T, Grehn F. Modern filtration surgery. An update. Ophthalmologe. 2013;110(4):299–305. doi: 10.1007/s00347-012-2710-0 [Article in German].CrossRefPubMedGoogle Scholar
  19. 19.
    Page MA, Fraunfelder FW. Safety, efficacy, and patient acceptability of lidocaine hydrochloride ophthalmic gel as a topical anesthetic for use in ophthalmic procedures. Clin Ophthalmol. 2009;3:601–9.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Geffen N, Carrillo MM, Jin Y, Trope GE, Buys YM. Effect of local anesthesia on trabeculectomy success. J Glaucoma. 2008;17(8):658–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Kansal S, Moster MR, Gomes MC, et al. Patient comfort with combined anterior sub-Tenon’s, topical and intracameral anesthesia versus retrobulbar anesthesia in trabeculectomy, phacotrabeculectomy and aqueous shunt surgery. Ophthalmic Surg Lasers. 2002;33:456–62.PubMedGoogle Scholar
  22. 22.
    Gyasi M, Amoaku W, Debrah O, et al. Outcome of trabeculectomies without adjunctive antimetabolites. Ghana Med J. 2006;40(2):39–44.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Jongsareejit B, Tomidokoro A, Mimura T, et al. Efficacy and complications after trabeculectomy with mitomycin C in normal-tension glaucoma. Jpn J Ophthalmol. 2005;49(3):223–7.CrossRefPubMedGoogle Scholar
  24. 24.
    De Fendi LI, Arruda GV, Scott IU, et al. Mitomycin C versus 5-fluorouracil as an adjunctive treatment for trabeculectomy: a meta-analysis of randomized clinical trials. Clin Experiment Ophthalmol. 2013;41(8):798–806.CrossRefPubMedGoogle Scholar
  25. 25.
    Hagiwara Y, Yamamoto T, Kitazawa Y. The effect of mitomycin C trabeculectomy on the progression of visual field defect in normal-tension glaucoma. Graefes Arch Clin Exp Ophthalmol. 2000;238(3):232–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Bhandari A, Crabb DP, Poinoosawmy D, et al. Effect of surgery on visual field progression in normal-tension glaucoma. Ophthalmology. 1997;104(7):1131–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Koseki N, Araie M, Shirato S, et al. Effect of trabeculectomy on visual field performance in central 30 degrees field in progressive normal-tension glaucoma. Ophthalmology. 1997;104(2):197–201.CrossRefPubMedGoogle Scholar
  28. 28.
    Mastropasqua L, Carpineto P, Ciancaglini M, et al. Delayed post-operative use of 5-fluorouracil as an adjunct in medically uncontrolled open angle glaucoma. Eye (Lond). 1998;12(pt4):701–6.CrossRefGoogle Scholar
  29. 29.
    Yamamoto T, Sawada A, Mayama C, et al. The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2. Ophthalmology. 2014;121(5):1001–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Weinreb RN. Adjusting the dose of 5-fluorouracil after filtration surgery to minimize side effects. Ophthalmology. 1987;94(5):564–70.CrossRefPubMedGoogle Scholar
  31. 31.
    Ruderman JM, Welch DB, Smith MF, et al. A randomized study of 5-fluorouracil and filtration surgery. Am J Ophthalmol. 1987;104(3):218–24.CrossRefPubMedGoogle Scholar
  32. 32.
    Zhong H, Sun G, Lin X, et al. Evaluation of pirfenidone as a new postoperative antiscarring agent in experimental glaucoma surgery. Invest Ophthalmol Vis Sci. 2011;52(6):3136–42.CrossRefPubMedGoogle Scholar
  33. 33.
    Menda SA, Lowry EA, Porco TC et al. Ex-PRESS outcomes using mitomycin-C, Ologen alone, Ologen with 5-fluorouracil. Int Ophthalmol 2014 [Epub ahead of print]Google Scholar
  34. 34.
    Membrey WL, Bunce C, Poinoosawmy DP, et al. Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 visual field progression. Br J Ophthalmol. 2001;85(6):696–701.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Wallin O, Al-ahramy AM, Lundstrom M, et al. Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single-centre retrospective study. Acta Ophthalmol. 2014;92(5):426–31.CrossRefPubMedGoogle Scholar
  36. 36.
    Kirwan JF, Lockwood AJ, Shah P, et al. Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology. 2013;120(12):2532–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Shingleton BJ, Pasternack JJ, Hung JW, et al. Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma. 2006;15(6):494–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Mansberger SL, Gordon MO, Jampel H, et al. Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology. 2012;119(9):1826–31.PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Salbaugh MA, Bojikian KD, Moore DB, et al. Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients. J Cataract Refract Surg. 2014;40(4):528–44.Google Scholar
  40. 40.
    Salaga-Pylak M, Kowal M, Zamoqski T. Deterioration of filtering bleb morphology and function after phacoemulsification. BCM Ophthalmol. 2013;13:17. doi: 10.1186/1471-2415-13-17.Google Scholar
  41. 41.
    Peponis VG, Chalkiadakis SE, Katzakis MC, et al. The effect of phacoemulsification on late bleb failure or intraocular pressure in patients with glaucoma: a systematic review. Clin Ophthalmol. 2012;6:1045–9.PubMedCentralPubMedGoogle Scholar
  42. 42.
    Augustinus CJ, Zeyen T. The effect of phacoemulsification and combined phaco/glaucoma procedures on the intraocular pressure in open-angle glaucoma. A review of the literature. Bull Soc Belge Ophthalmol. 2012;320:51–66.Google Scholar
  43. 43.
    Patel HY, Danesh-Meyer HV. Incidence and management of cataract after glaucoma surgery. Curr Opin Ophthalmol. 2013;24(1):15–20.CrossRefPubMedGoogle Scholar
  44. 44.
    Shi JM, Jia SB. Selective laser trabeculoplasty. Int J Ophthalmol. 2012;5(6):742–9.PubMedCentralPubMedGoogle Scholar
  45. 45.
    Schwartz AL, Perman KI, Whitten M. Argon laser trabeculoplasty in progressive low-tension glaucoma. Ann Ophthalmol 1984; 16(6):560–2, 566Google Scholar
  46. 46.
    Nitta K, Sugiyama K, Mawatari Y, et al. Results of selective laser trabeculoplasty (SLT) as initial treatment for normal tension glaucoma. Nihon Ganka Gakkai Zasshi. 2013;117(4):335–43 [Article in Japanese].PubMedGoogle Scholar
  47. 47.
    Lee JW, Liu CC, Chan JC, Lai JS. Predictors of success in selective laser trabeculoplasty for Chinese open-angle glaucoma. J Glaucoma. 2014;23(5):321–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Lee TE, Kim YY, Yoo C. Retinal vessel diameter in normal-tension glaucoma patients with asymmetric progression. Graefes Arch Clin Exp Ophthalmol. 2014 [Epub ahead of print].Google Scholar
  49. 49.
    Tojo N, Oka M, Miyakoshi A, et al. Comparison of fluctuations of intraocular pressure before and after selective laser trabeculoplasty in normal-tension glaucoma patients. J Glaucoma. 2013 [Epub ahead of print].Google Scholar
  50. 50.
    Hirn C, Zweifel SA, Toteberg-Harms M, et al. Effectiveness of selective laser trabeculoplasty in patients with insufficient control of intraocular pressure despite maximum tolerated medical therapy. Opthalmologe. 2012;109(7):683–90 [Article in German].CrossRefGoogle Scholar
  51. 51.
    Lee LC, Pasquale LR. Surgical management of glaucoma in pseudophakic patients. Semin Ophthalmol. 2002;17(3–4):131–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Mahdaviani S, Kitnarong N, Kropf JK, et al. Efficacy of laser trabeculoplasty in phakic and pseudophakic patients with primary open-angle glaucoma. Ophthalmic Surg Lasers Imaging. 2006;37(5):394–8.PubMedGoogle Scholar
  53. 53.
    Werner M, Smith MF, Doye JW. Selective laser trabeculoplasty in phakic and pseudophakic eyes. Ophthalmic Surg Lasers Imaging. 2007;38(3):182–8.PubMedGoogle Scholar
  54. 54.
    Shazly TA, Latina MA, Dagianis JJ, et al. Effect of prior cataract surgery on the long-term outcome of selective laser trabeculoplasty. Clin Ophthalmol. 2011;5:377–80.PubMedCentralCrossRefPubMedGoogle Scholar
  55. 55.
    Seymenoglu G, Baser EF. Efficacy of selective laser trabeculoplasty in phakic and pseudophakic eyes. J Glaucoma. 2015;24(2):105–10 [Epub ahead of print].CrossRefPubMedGoogle Scholar
  56. 56.
    Li EY, Than CC, Chi SC, et al. Cost-effectiveness of treating normal tension glaucoma. Invest Ophthalmol Vis Sci. 2013;54(5):3394–9.CrossRefPubMedGoogle Scholar
  57. 57.
    El Mallah MK, Walsh MM, Stinnett SS, et al. Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients. Clin Ophthalmol. 2010;4:889–93.PubMedCentralPubMedGoogle Scholar
  58. 58.
    Minckler DS, Vedula SS, Li TJ, et al. Aqueous shunts for glaucoma. Cochrane Database Syst Rev. 2006;19(2), CD004918.Google Scholar
  59. 59.
    Yip LW, Yong SO, Earnest A, et al. Endoscopic cyclophotocoagulation for the treatment of glaucoma: an Asian experience. Clin Experiment Ophthalmol. 2009;37(7):692–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Koseki N, Araie M, Tomidokoro A, et al. A placebo-controlled 3-year study of a calcium blocker on visual field and ocular circulation in glaucoma with low-normal pressure. Ophthalmology. 2008;115(11):2049–57.CrossRefPubMedGoogle Scholar
  61. 61.
    Song BJ, Caprioli J. New directions in the treatment of normal tension glaucoma. Indian J Ophthalmol. 2014;62(5):529–37.PubMedCentralCrossRefPubMedGoogle Scholar
  62. 62.
    Friedman NJ, Kaiser PK, Pineda R. Optic nerve and glaucoma. In: The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology, 3rd ed. China: Saunders Elsevier, 2009. p. 516Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Center for Advanced Eye CareVero BeachUSA
  2. 2.New York Eye and Ear Infirmary of Mount SinaiNew YorkUSA

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