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Postoperative RNFL-Changes after Successful Trabeculectomy: 2-Year Outcomes.

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Summary

Trabeculectomy (TE) effectively lowers intraocular pressure and medication needs in glaucoma patients. However, retinal nerve fibre layer (RNFL) thickness continues to decrease post-surgery, stabilizing after a prolonged period.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Interventions

Background:

  • Glaucoma management aims to reduce intraocular pressure (IOP) to prevent retinal ganglion cell apoptosis.
  • Trabeculectomy (TE) is the established gold standard surgical treatment for glaucoma.
  • Assessing postoperative changes in the retinal nerve fibre layer (RNFL) is crucial for understanding surgical outcomes.

Purpose of the Study:

  • To analyze the changes in RNFL thickness after TE using optical coherence tomography (OCT).
  • To evaluate the long-term efficacy of TE in patients with primary open-angle glaucoma (POAG).

Main Methods:

  • Retrospective analysis of 40 treatment-naïve POAG patients undergoing TE.
  • Evaluation of IOP, medication use, visual acuity, perimetry, and peripapillary RNFL thickness via OCT up to 24 months post-TE.

Main Results:

  • TE significantly reduced mean IOP (25.0 to 13.9 mmHg) and medication requirements (3.3 to 0.5 drops).
  • Visual acuity and mean deviation remained stable post-surgery.
  • A significant decrease in mean global RNFL thickness was observed, from 67.8 µm pre-operatively to 63.7 µm at 12 months and 63.4 µm at 24 months (p<0.01).

Conclusions:

  • TE is effective in lowering IOP and reducing medication dependence in POAG patients.
  • Despite IOP control, significant RNFL thinning occurs in the first 12 months after TE.
  • RNFL thickness appears to stabilize only after an extended postoperative period.