Optic disc and visual field changes following trabeculectomy
Aachal Kotecha 1*,
Alexander Spratt 2,
Catey Bunce 3,
David F. Garway-Heath 4,
Peng T. Khaw 5,
and
Ananth Viswanathan 6
1 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Optometry, City University, Northampton Square, London, EC1V 0HS, United Kingdom; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
2 Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
3 Research and Development, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
4 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Optometry, City University, Northampton Square, London, EC1V 0HS, United Kingdom
5 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
6 Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Optometry, City University, London, United Kingdom
* To whom correspondence should be addressed. E-mail: aachalkotecha{at}gmail.com.
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Abstract |
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Purpose: To assess the changes in optic nerve head (ONH) structure and visual field (VF) sensitivity over time in a cohort of glaucoma patients following trabeculectomy.
Methods: The MoreFlow Medical Research Council 5-Flurouracil (5-FU) study was an 80 month prospective randomised control trial of per-operative 5-FU versus placebo on the outcomes of primary trabeculectomy. Heidelberg Retina Tomograph ONH imaging and Humphrey Field Analyser full-threshold 24-2 VF testing was performed pre-operatively and at regular intervals post-operatively. ONH images were analysed using linear regression of sector rim area (RA) over time with change defined as a significant slope >1% of baseline RA per year in any sector. VF were analysed using pointwise linear regression analysis (PLRA) techniques. Patients' median IOP level, intervisit IOP fluctuation and percentage reduction in IOP over follow-up period were also determined.
Results: Two hundred and fifty eyes of 255 patients were included. Of these, 70 eyes were deemed to be progressing approximately 5 years following surgery: 20 eyes by ONH alone, 35 by VF alone and 15 by both methods. Eyes showing changes in both ONH and VF sensitivity had slightly higher median follow-up IOP and lower degrees of IOP reduction from baseline compared with eyes showing no progression.
Conclusions: The study demonstrates that approximately one third of eyes continue to show progression of glaucoma at 5 years, as determined by trend based analysis of ONH structural changes and VF sensitivity over time.
Key Words:
glaucoma surgery, optic disc, visual field
