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Abstract #46015 Published in IGR 13-2
Effect of successful and partly successful filtering surgery on the velocity of glaucomatous visual field progression
Folgar FA; De Moraes CG; Teng CC; Tello C; Ritch R; Liebmann JMJournal of Glaucoma 2011;
PURPOSE: We sought to determine whether filtering surgery, even when only partially successful, delays or slows visual field (VF) progression. METHODS: The records of all patients seen in a glaucoma referral practice from 1999 to 2009 were reviewed. Group A comprised eyes with (greater-than or equal to)5 VFs before surgery and group B comprised eyes with (greater-than or equal to)5 VFs after surgery. Eyes in group B were further divided into those requiring postoperative topical ocular hypotensive therapy (group B-2) and those that did not (group B-1). Automated pointwise linear regression was used to determine global rates (dB/y) of change and progression endpoints. A progression endpoint was determined when 2 or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of (greater-than or equal to)1.0 dB/year with P<0.01. RESULTS: A total of 206 treated eyes (206 patients; mean age, 63.8(plus or minus)13.0 y; 11.3(plus or minus)3.1 VFs; 6.4(plus or minus)1.8 y follow-up) were included. Mean global VF progression rates in group A (-0.86(plus or minus)0.8 dB/y) were faster than those in group B (-0.49(plus or minus)0.9 dB/y, P<0.01). Group A also had a greater risk of reaching a progression endpoint compared with group B (odds ratio=2.41, P<0.01). Groups B-1 and B-2 had different follow-up intraocular pressure means (12.7(plus or minus)3.7 vs. 15.5(plus or minus)2.7 mm Hg, respectively; P<0.01) and peaks (19.4(plus or minus)5.2 vs. 21.2(plus or minus)4.2 mm Hg; P=0.08). The velocity of VF progression was similar for groups B-1 and B-2 (-0.40(plus or minus)0.6 vs. -0.58(plus or minus)1.1 dB/y; P=0.22) and there was no significant difference between the 2 groups regarding the risk of reaching a progression endpoint (odds ratio=0.83, P=0.62). CONCLUSIONS: Filtering surgery reduces the rate of disease progression and this effect persists even if adjunctive glaucoma medical therapy is required.
F. A. Folgar.
Classification:
13.2.2.1 Progression (Part of: 13 Therapeutic prognosis and outcome > 13.2 Outcome > 13.2.2 Visual field)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)