The Effect of Glaucoma Filtration Surgery on Structural and Functional Eye Parameters in a Short-Term Study

Open access

Abstract

Glaucoma filtration surgery (trabeculectomy) is an effective glaucoma treatment method that provides significant intraocular pressure (IOP) reduction. Indications for this method are in cases where other forms of therapy, like medicines or lasers, have failed, other forms of therapy are not suitable (compliance or side-effects are a problem), in cases where a target pressure is required to prevent clinically significant disease progression that cannot be reached with topical medications and/or laser and in cases that have such advanced glaucoma and high IOP at presentation that other forms of treatment are unlikely to be successful. The aim of this study was to evaluate the effect of glaucoma surgery on the structural and functional eye parameters at different stages of glaucoma. A total of 96 eyes of 96 patients (only one eye from each patient) with different stages of glaucoma (stages 2 to 4) who were undergoing trabeculectomy were recruited. Quadrant retinal nerve fibre layer RNFL) thickness (33 patients), cup/disc vertical and horizontal ratio (36 patients) and MD of visual fields (27 patients) were analysed up to one week before and 1 month after the successful surgery. The results show that the MD value was slightly improved in 50%, 85.7%, and 71.4% of patients with glaucoma stages 2, 3, and 4, respectively. The mean RNFL of all four optic nerve head quadrants increased slightly after the surgery for patients with glaucoma stage 2; in contrast, a decrease in the mean RNFL values for all four quadrants was observed for patients with glaucoma stage 4. Statistically significant changes in the mean values for the optic nerve horizontal c/d ratio after glaucoma surgery were observed (p = 0.033) in contrast to the vertical c/d values (p = 0.77). In total, improvement of the horizontal and vertical c/d ratio was detected in 61.1% and 55.6% of the glaucoma patients, respectively. Although the observed changes were statistically insignificant, the positive influence of glaucoma surgery on the structural and functional eye parameters was more pronounced in moderate stages than in advanced or severe stages of glaucoma.

Anonymous (2017). Terminology and Guidelines for Glaucoma. 4th edn. ISBN: 978-88-98320-05-9. Available at: http://www.eugs.org/eng/EGS_guidelines.asp (accessed 22 February 2017).

Aydin, A., Wollstein, G., Price, L. L., Fujimoto, J. G., Schuman, J. S. (2003). Optical coherence tomography assessment of retinal nerve fiber layer thickness changes after glaucoma surgery. Ophthalmology, 110, 1506-1511.

Bengtsson, B., Heijl, A. (2008). A visual field index for calculation of glaucoma rate of progression. Amer. J. Ophthalmol., 145, 343-353.

Bertrand, V., Fieuws, S., Stalmans, I., Zeyen, T. (2014). Rates of visual field loss before and after trabeculectomy. Acta Ophthalmologica, 92, 116-120.

Chang, P. T., Sekhon, N., Budenz, D. L., Feuer, W. J., Park, P. W., Anderson, D. R.(2007). Effect of lowering intraocular pressure on optical coherence tomography measurement of peripapillary retinal nerve fiber layer thickness. Ophthalmology, 114, 2252-2258.

Coleman, A. L., Quigley, H. A., Vitale, S., Dunkelberger, G. (1999). Displacement of the optic nerve head by acute changes in intraocular pressure in monkey eyes. Ophthalmology, 98, 35-40.

Flanangan, J. G. (1998). Glaucoma update: Epidemiology and new approaches to medial management. Ophthalmic Physiol. Opt., 18, 126-132.

Grieshaber, M. C., Flammer, J. (2007). Fundamental sciences in glaucoma. Introduction. Surv. Ophthalmol., 52 (suppl. 2), 99-100.

Gupta, D. (2005). Glaucoma Diagnosis and Management. Lippincott Williams & Wilkins,Philadelphia, pp. 273-274.

Hattenhauer, M. G., Johnson, D. H., Ing, H. H., Herman, D. C., Hodge, D. O., Yawn, B. P., Butterfield, L. C., Gray, D. T. (1998). The probability of blindness from open-angle glaucoma. Ophthalmology, 105, 2099-2104.

Heijl, A., Leske, M. C., Bengtsson, B., Hyman L, Bengtsson B, Hussein M; Early Manifest Glaucoma Trial Group. (2002). Reduction of intraocular pressure and glaucoma progression: Results from Early Manifest Glaucoma Trial. Arch. Ophthalmol., 120, 1268-1279.

Hodapp, E., Parrish, R. K., Anderson, D. R. (1993). Clinical Decisions in Glaucoma. Mosby-Year Book, St. Louis, 204 pp.; see pp. 84-125.

Kass, M. A., Heuer, D. K., Higginbotham, E. J., Johnson, C. A., Keltner, J. L., Miller, J. P., Parrish, R. K. 2nd, Wilson, M. R., Gordon, M. O. (2002). The ocular hypertension treatment study: A randomized trial determines that optical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch. Ophthalmol., 120, 701-713.

Kim, T.-W., Park, U.-C., Park, K., H.., Kim, D., M. (2007). Ability of Stratus OCT to identify localized retinal nerve fiber layer defects in patients with normal standard automated perimetry results, Invest. Ophthalmol. Vis. Sci. 48 (4), 1635-1641.

Kotecha, A., Spratt, A., Bunce, C., Garway-Heath, D. F., Khaw, P. T., Viswanathan, A., More Flow Study Group. (2009). Optic disc and visual field changes after trabeculectomy. Invest. Ophthalmol. Vis. Sci., 50, 4693-4699.

Lamping, K. A., Bellows, A. R., Hutchinson, B. T., Afran, S. I. (1986). Long-term evaluation of initial filtration surgery. Ophthalmology, 93, 91-101.

Leske, M., C., Heijl, A., Hussein, M., Bengtsson, B., Hyman, L., Komaroff, E.; Early Manifest Glaucoma Trial Group. (2003). Factors for glaucoma progression and the effect of treatment. Arch. Ophthalmol., 121, 48-56.

Mills, R., P., Budenz, D. L., Lee, P. P., Noecker, R. J., Walt, J. G., Siegartel, L. R., Evans, S. J., Doyle, J. J.(2006). Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Amer. J. Ophthalmol., 141, 24-30.

Raghu, N., Pandav, S.. S., Kaushik, S., Ichhpujani, P., Gupta, A. (2012). Effect of trabeculectomy on RNFL thickness and optic disc parameters using optical coherence tomography. Eye, 26, 1131-1137.

Rebolleda, G., Muñoz-Negrete, F., Noval, S. (2007). Evaluation of changes in peripapillary nerve fiber layer thickness after deep scleretomy with optical coherence tomography. Ophthalmology, 114, 488-493.

Sarkar, K., C, Das, P., Pal, R., Shaw, C. (2014). Optical coherence tomographic assessment of retinal nerve fiber layer thickness changes before and after glaucoma filtration surgery. Oman J. Ophthalmol., 7, 3-8.

Shirakashi, M., Nanbam K., Iwata, K. (1991). Changes in reversal of cupping in experimental glaucoma. Ophthalmology, 99, 1104-1110.

Sihota, R., Sony P., Gupta V., Dada, T., Singh, R. (2006). Diagnostic capability of optical coherence tomography in evaluating the degree of glaucomatous retinal nerve fiber damage. Invest. Ophthalmol. Vis Sci., 47, 2006-2010.

Sommer, A., Katz, J., Quigley, H. A., Miller, N. R., Robin, A. L., Richter, R. C., Witt, K. A. (1991). Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch. Ophthalmol., 109, 77-83.

Topouzis, F., Peng, F., Kotas-Neumann, R., Garcia, R, Sanguinet, J, Yu, F, Coleman, A. L. (1999). Longitudinal changes in optic disc topography of adult patients after trabeculectomy. Ophthalmology, 106, 1147-1151.

Weinreb, R. N., Friedman, D. S., Fechtner, R. D., Cioffi, G. A., Coleman, A. L., Girkin, C. A., Liebmann, J. M., Singh, K., Wilson, M. R., Wilson, R., Kannel, W. B. (2004). Risk assessment in the management of patients with ocular hypertension. Amer. J. Ophthalmol, 138, 458-467.

Weinreb, R. N., Khaw, P. T. (2004). Primary open-angle glaucoma. Lancet, 363, 1711-1720.

Journal Information


CiteScore 2016: 0.20

SCImago Journal Rank (SJR) 2016: 0.138
Source Normalized Impact per Paper (SNIP) 2016: 0.217

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 38 38 18
PDF Downloads 10 10 7