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One year structural and functional glaucoma progression after trabeculectomy.

Jacqueline Chua1,2, Aistė Kadziauskienė3,4, Damon Wong5,6

  • 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.

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Summary

Trabeculectomy can initially improve visual fields (VF) in glaucoma patients, but long-term decline is observed. Retinal nerve fibre layer (RNFL) thickness also decreases post-surgery, especially in severe glaucoma cases.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Outcomes

Background:

  • Trabeculectomy is a common surgical procedure for glaucoma.
  • Monitoring visual field (VF) mean deviation (MD) and retinal nerve fibre layer (RNFL) thickness is crucial for assessing glaucoma progression.
  • Understanding post-surgical changes is vital for patient management.

Purpose of the Study:

  • To evaluate changes in VF MD and RNFL thickness in glaucoma patients after trabeculectomy over one year.
  • To identify factors associated with VF and RNFL changes post-surgery.

Main Methods:

  • Prospective study of 100 glaucoma patients undergoing trabeculectomy.
  • Assessment of VF and spectral-domain optical coherence tomography (OCT) for RNFL thickness at baseline and four follow-up visits over one year.
  • Linear mixed models used to analyze factors influencing VF and RNFL changes.

Main Results:

  • VF initially improved within 3 months post-trabeculectomy, then showed deterioration.
  • RNFL thickness showed a consistent reduction over the follow-up period.
  • Absence of initial VF improvement, RNFL thinning, increasing intraocular pressure (IOP), and severe glaucoma were associated with VF deterioration.
  • VF deterioration, increasing IOP, and moderate to severe glaucoma were linked to RNFL thinning.

Conclusions:

  • Trabeculectomy leads to observable changes in both RNFL structure and function within one year.
  • Early VF improvement is more common in mild to moderate glaucoma, while severe cases experience greater decline.
  • OCT can detect glaucoma progression even in late-stage disease post-surgery.