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Abstract #6558 Published in IGR 3-2
Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 visual field progression
Membrey WL; Bunce C; Poinoosawmy DP; Fitzke FW; Hitchings RABritish Journal of Ophthalmology 2001; 85: 696-701
BACKGROUND: Reduction of intraocular pressure (IOP) by 20-30% with glaucoma drainage surgery slows disease progression in normal-tension glaucoma (NTG). It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring. METHODS: sixty-one eyes of 61 white patients with NTG who had undergone a primary guarded fistulizing procedure, were reviewed. Twenty eyes had no antiproliferatives (nil), 29 had peroperative 5-fluorouracil (5-FU), and 12 had peroperative mitomycin C (MMC). Pointwise linear regression analysis (Progressor for Windows software) was applied to their visual field series, starting with the first visual field following surgery and adding subsequent visual fields one at a time. Progression of visual field loss was defined as the appearance of a regression slop 1 dB per year or more with a significance of p < 0.01 at one or more visual field locations, which remained consistent with the addition of two of three successive visual fields. Time updated covariate analysis was used to determine the relation between variables that changed with time, such as IOP, and the risk of progression. RESULTS: The median percentage IOP reduction was 24.4 for the nil group, 38.0 for the 5-FU group, and 47.5 for the MMC group (p = 0.001). There was a statistically significant relation between percentage change in IOP and risk of visual field progression in the subsequent six-month period for all patients analyzed as one group, hazard ratio = -0.021 (p = 0.002). There was a statistically significant increase in the risk of visual field progression for the MMC group compared with the 5-FU group, hazard ratio = 1.51 (p = 0.02). CONCLUSIONS: In NTG patients, the IOP reduction produced by drainage surgery reduces the risk that visual field progression may be reduced after drainage surgery; this is related to the level of IOP reduction. The percentage drop in IOP during a given time is related to the risk of subsequent visual field progression. However, the use of MMC is associated with a greater risk of visual field progression, despite a greater fall in IOP. This visual field deterioration may be related to the functional loss produced by late postoperative complications which have been reported at a higher rate in this group. The use of adjunctive perioperative 5-FU should maintain a suitable target IOP with preservation of visual function without the additional complications and associated visual deterioration seen with adjunctive MMC.
Mr R.A. Hitchings, Glaucoma Unit, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK. roger.hitchings@virgin.net
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
