Intraocular surgery in advanced glaucoma

Loss of visual field subserving macular function has been found to be rare after intraocular surgery in advanced glaucoma. Abrupt changes in refractive error, lens opacity, and suppression must be carefully excluded before macular fixation is deemed lost. Out of 69 intraocular procedures (46 drainage operations, 13 cataract extractons) two patients lost central visual field subserving macular fixation possibly as a result of surgery. There is an increased incidence of postoperative maculopathy in late glaucoma. Three drainage operations out of 46 and four cataract extractions out of 13 had this complication. Altogether 30% of drainage procedures induced deterioration of visual acuity of lenticular origin to a level normally requiring cataract extraction. Trabeculectomy was found to be less likely to cause this sequela than the Scheie procedure at the 6 month postoperative stage. However, 77% of patients with advanced glaucoma and cataract obtained a satisfactory improvement in visual status after cataract extraction.