Visual Field Progression After Glaucoma Surgery in Pseudoexfoliation versus Primary Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Pseudoexfoliation glaucoma (XFG) and primary open-angle glaucoma (POAG) are leading causes of irreversible blindness.
• Filtering surgery is a common intervention to reduce intraocular pressure (IOP) in glaucoma patients.
• Understanding visual field progression post-surgery is critical for long-term vision preservation.

Purpose of the Study:

• To compare visual field progression between pseudoexfoliation glaucoma (XFG) and primary glaucoma (POAG, PACG) after IOP reduction via filtering surgery.
• To identify factors influencing visual field progression in these glaucoma subtypes post-operatively.

Main Methods:

• A prospective study included 32 XFG, 33 POAG, and 28 primary angle closure glaucoma (PACG) patients undergoing filtering surgery.
• Visual field progression was assessed using guided progression analysis (GPA).
• Multivariate regression analysis identified factors associated with visual field progression.

Main Results:

• No significant difference in final IOP or mean rate of progression (ROP) between XFG and primary glaucoma groups.
• XFG eyes showed a higher incidence of ROP worse than -5dB/year and more frequent IOP spikes (>5mm Hg).
• Higher IOP fluctuations (>5mm Hg) and associated retinal vein occlusions (RVO) were significant predictors of visual field progression in XFG and POAG eyes.

Conclusions:

• Elevated IOP fluctuations and RVO are key predictors of visual field progression after glaucoma filtering surgery in XFG and POAG.
• Effective management requires addressing both IOP-dependent and independent mechanisms of visual field progression.