Long-Term Vision After Trabeculectomy
British Journal of Ophthalmology
Published online Sept. 19, 2020
For many patients, the main goal of trabeculectomy is adequate vision for their remaining years. However, data on whether this goal is being achieved are lacking. To fill the gap, Chen and King quantified vision after trabeculectomy by documenting visual acuity (VA) and visual field status from surgery to the last follow-up visit. They found that in most patients, vision remained stable postoperatively. For the others, visual loss often was unrelated to glaucoma.
This study population underwent trabeculectomy performed by the same surgeon between October 2000 and November 2012. The authors collected demographic data as well as clinical measurements from surgery until patient death. Preoperative values served as baseline data for outcome comparisons.
Among the 659 patients who received trabeculectomy in the study period, 160 (24.3%) died before November 2018. Of these, 156 (196 eyes) had sufficient information for study inclusion. The most common disease type was primary open-angle glaucoma (69% of eyes). Fifty-eight percent of patients were male, and 86% were white. The mean age at surgery on the first eye was 76.5 years. The average life expectancy after trabeculectomy was 7.5 years (range, 0.1 to 17.2 years).
The mean individual change in VA, measured as LogMAR (standard deviation), was 0.32 (0.59). For patients with at least one year of follow-up (n = 144), the median visual field deviation was ‒0.44 dB/year (range, ‒5.98 to 3.9 dB/year). Severe vision loss (≥10 letters) by end of life occurred in 78 eyes (40%); in 18 eyes (9%), the worsening VA resulted from glaucoma progression. At the last follow-up visit, 69 patients (44%) were using glaucoma drops. There was no link between socioeconomic status and preoperative mean deviation or change in mean deviation from baseline to last measurement.
These findings indicate that trabeculectomy slows or prevents glaucoma progression in most patients, regardless of the person’s socioeconomic status. Those who lost vision generally were older and had poorer baseline VA and visual field status, and the functional decline was unrelated to glaucomain most cases. With life expectancy continuing to increase, the authors recommend more research on the lifetime value of trabeculectomy.
The original article can be found here.