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Fang CEH, Hakim MT, Siddiqui MM, Armstrong D, Shankar V. A retrospective study to assess visual field improvement following augmented trabeculectomy. Indian J Ophthalmol 2023; 71:1953-1959. [PMID: 37203064 PMCID: PMC10391496 DOI: 10.4103/ijo.ijo_2071_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To explore the visual field (VF) changes two years following augmented trabeculectomy. Methods A retrospective study of patients who underwent augmented trabeculectomy surgery with mitomycin C by a single surgeon at East Lancashire Teaching Hospitals NHS Trust over 3 years. Patients with a minimum of two years postoperative follow-up were included. Baseline characteristics, intraocular pressure (IOP), VF, number of glaucoma medications, and complications were recorded. Results In total, 206 eyes were included, 97 (47%) patients were female, and the mean age was 73.8 ± 10.3 (range 43 to 93) years. One hundred thirty-one (63.6%) eyes were pseudophakic before trabeculectomy. The patients were divided into three outcome groups according to VF outcome. Seventy-seven (37.4%) patients had stable VF, 35 (17.0%) patients showed VF improvement, and 94 (45.6%) had VF deterioration. The overall mean preoperative IOP was 22.7 ± 8.0 mmHg and postoperative IOP 10.4 ± 4.2 mmHg, with a reduction of 50.2% (P < 0.001). In total, 84.5% of postoperative patients did not require glaucoma medications. A higher number of patients with postoperative IOP ≥15 mmHg had deteriorating VF (P < 0.001). Based on preoperative MD distribution, VF improvement or stability was more achievable with patients with a preoperative VF defect up to -12 dB (n = 41, 59.4%) and in those with greater than -24 dB (n = 25, 64.1%). Conclusion Trabeculectomy continues to be an effective means of lowering IOP in patients with uncontrolled glaucoma and is important in stabilizing or improving visual fields. We recommend early trabeculectomy to prevent further VF deterioration. This may help in maintaining VF for driving status and, thus, quality of life.
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Affiliation(s)
- Clarissa E H Fang
- Ophthalmology Department, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Mohamad T Hakim
- Ophthalmology Department, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Muhammad M Siddiqui
- Ophthalmology Department, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Deborah Armstrong
- Ophthalmology Department, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Vikas Shankar
- Ophthalmology Department, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
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Aihara M, Lu F, Kawata H, Iwata A, Odani-Kawabata N. Twelve-month efficacy and safety of omidenepag isopropyl, a selective EP2 agonist, in open-angle glaucoma and ocular hypertension: the RENGE study. Jpn J Ophthalmol 2021; 65:810-819. [PMID: 34495425 DOI: 10.1007/s10384-021-00868-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the long-term safety and efficacy of omidenepag isopropyl (OMDI) 0.002% (a first-in-class, selective, non-prostaglandin, prostanoid EP2 receptor agonist), alone or administered concomitantly with timolol 0.5%, in patients with open-angle glaucoma (OAG, including normal-tension and exfoliation glaucoma) or ocular hypertension (OHT). STUDY DESIGN Open-label, multicenter, Phase 3 study (NCT02822729). METHODS Patients aged ≥ 20 years, with OAG or OHT, and a baseline diurnal intraocular pressure (IOP) ≥ 16- < 22 mmHg (Group 1) or ≥ 22- ≤ 34 mmHg (Groups 2 and 3) were enrolled. All patients (N = 125) received OMDI 0.002% once daily. Group 3 also received timolol 0.5% twice daily. IOP was measured at baseline and at Weeks 2, 4, 8, 12, 26, 40, and 52. RESULTS Significant reductions in mean diurnal IOP from baseline occurred at every visit (P < 0.0001). Mean ± SE diurnal IOP reduction at Week 52 was -3.7 ± 0.3 mmHg (Group 1), -5.6 ± 0.5 mmHg (Group 2), and -8.4 ± 0.6 mmHg (Group 3). Most adverse events (AEs) were mild, and no serious treatment-related AEs were reported. Conjunctival hyperemia (incidence: monotherapy [Groups 1 and 2], 18.8%; concomitant [Group 3], 45.0%) and macular edema (ME)/cystoid macular edema (CME) (incidence: monotherapy, 11.8%; concomitant, 15.0%) occurred most frequently. All treatment-related ME/CME cases occurred in pseudophakic eyes and responded to standard-of-care treatment and study drug discontinuation. CONCLUSIONS In this study, OMDI 0.002%, alone or administered concomitantly with timolol 0.5%, resulted in sustained IOP reduction over 52 weeks in patients with OAG or OHT. Concomitant treatment resulted in increased efficacy and increased incidence of conjunctival hyperemia.
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Affiliation(s)
| | - Fenghe Lu
- Santen Inc., 6401 Hollis Street, Suite 125, Emeryville, CA, 94608, USA.
| | | | | | - Noriko Odani-Kawabata
- Santen Inc., 6401 Hollis Street, Suite 125, Emeryville, CA, 94608, USA.,Santen Pharmaceutical Co., Ltd., Osaka, Japan
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Central visual field change after fornix-based trabeculectomy in Japanese normal-tension glaucoma patients managed under 15 mmHg. Graefes Arch Clin Exp Ophthalmol 2021; 259:2309-2316. [PMID: 33929590 DOI: 10.1007/s00417-021-05215-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate how the central visual field would be changed after fornix-based trabeculectomy with mitomycin C in Japanese normal-tension glaucoma (NTG) patients monitored for more than 10 years including before surgery. METHODS This is a retrospective cohort study. We identified twenty-eight eyes of 28 NTG cases regularly monitored for more than 5 years and examined static visual field (VF) tests for more than five times before and after fornix-based trabeculectomy (including combined surgery). Based on preoperative data for 6.3 years, we evaluated postoperative changes for 6.0 years in 10-2 VF and 30-2 VF. RESULTS Six patients were male and 22 females, the mean age was 57.9 years, and the mean deviation was - 13.7 decibels. After surgery, mean IOP decreased from 13.9 to 9.0 mmHg (P ≤ 0.01), and medication score also did. The rate of 10-2 VF deterioration was significantly suppressed from - 1.0 dB/year preoperatively to - 0.4 dB/year postoperatively (P ≤ 0.01). And when 30-2 VF was divided into six relevant sectors, the rate of deterioration at cecocentral and arcuate areas of the superior hemifield was suppressed postoperatively (P ≤ 0.01 and P = 0.042, respectively). CONCLUSION Based on long-term preoperative data, a significant positive change in 10-2 VF was observed after fornix-based trabeculectomy with mitomycin C in Japanese NTG patients with a mean IOP of 13.9 mmHg. Central vision could be expected to be maintained for NTG patients even if its preoperative IOP is low after successful trabeculectomy.
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Fujita A, Sakata R, Ueda K, Nakajima K, Fujishiro T, Honjo M, Shirato S, Aihara M. Evaluation of fornix-based trabeculectomy outcomes in Japanese glaucoma patients based on concrete long-term preoperative data. Jpn J Ophthalmol 2021; 65:306-312. [PMID: 33420539 DOI: 10.1007/s10384-020-00797-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the outcomes of fornix-based trabeculectomy in Japanese patients with glaucoma based on more than five years of preoperative data. STUDY DESIGN Retrospective case series METHODS: This study consisted of 35 eyes of 35 Japanese glaucoma patients (mean age: 60.6, standard deviation (SD) 11.5 years) who received initial fornix-based trabeculectomy from a single ophthalmology clinic, with one or more reliable visual field test results per year from at least five years before and after the surgery. Measurements included postoperative mean intraocular pressure (IOP), standard deviation of IOP, medication scores, mean deviation slope, and total deviation slope were evaluated based on preoperative data. The relationship between mean IOP, SD-IOP and the visual field (VF) deterioration speed was also analysed. RESULTS The mean follow-up period before surgery was 6.15 (SD 0.97) years and post surgery it was 5.95 (SD 0.63) years. The preoperative mean IOP of 14.6 (SD 2.3) mmHg significantly decreased to 9.2 (SD 2.2) mmHg (P <.001). The preoperative medication score 2.7 (SD 0.5) significantly decreased to 0.1 (SD 0.4, P <.001). The preoperative MD slope of -0.52 (SE 0.047) dB/year significantly improved to -0.31 (SE 0.14) dB/year (P <.01), with improvement in the superior hemifield (P ≤.018). Inferior hemifield (P >.10) did not follow the trend. Neither mean IOP nor SD-IOP correlated with the VF deterioration speed. CONCLUSIONS Fornix-based trabeculectomy is an acceptable procedure for initial surgical management of glaucoma, especially for maintenance of superior VF.
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Affiliation(s)
- Asahi Fujita
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Yotsuya Shirato Eye Clinic, Tokyo, Japan.
| | - Koji Ueda
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kosuke Nakajima
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Showa General Hospital, Tokyo, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya Shirato Eye Clinic, Tokyo, Japan
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5
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Shirahama S, Kaburaki T, Takada S, Nakahara H, Tanaka R, Komae K, Fujino Y, Kawashima H, Aihara M. Comparison of visual field defect progression in secondary Glaucoma due to anterior uveitis caused by three types of herpes viruses. Graefes Arch Clin Exp Ophthalmol 2019; 258:639-645. [PMID: 31832767 DOI: 10.1007/s00417-019-04559-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To clarify the prevalence of secondary glaucoma (SG) and its speed of progression in patients with herpes simplex virus (HSV)-anterior uveitis (AU), varicella zoster virus (VZV)-AU, and cytomegalovirus (CMV)-AU. METHODS In total, 170 patients with herpetic AU were enrolled in this retrospective observational case series. Patients with visual field (VF) defects and glaucomatous disc abnormalities were diagnosed with SG. Moreover, the speed of SG progression was defined as decreasing mean deviation (MD) values per year. SG prevalence and annual MD-value decrease were compared among the three types of herpetic AU. RESULTS SG prevalence was 16%, 9%, and 72% in patients with HSV-AU, VZV-AU, and CMV-AU, respectively. Patients with CMV-AU had the highest SG prevalence (odds ratio = 3.15; 95% confidence interval = 1.15-8.65; P < 0.05). Furthermore, the annual MD-value change was significantly higher in SG caused by CMV-AU than in that caused by HSV/VZV-AU (-2.6 ± 2.4 dB/year and -0.45 ± 0.54 dB/year, respectively; P < 0.05). CONCLUSIONS Our results demonstrated that patients with CMV-AU may have a higher risk and faster speed of progression of SG than patients with HSV/VZV-AU. Therefore, clinicians should monitor glaucoma onset and VF-defect progression in patients with CMV-AU.
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Affiliation(s)
- Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Sachiko Takada
- Department of Ophthalmology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Abstract
PURPOSE The purpose of this study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and glaucoma progression, and to examine the correlation between OSAS severity and rate of visual field (VF) loss. METHODS Patients with concurrent diagnoses of open-angle glaucoma and OSAS between 2010 and 2016 were identified. Enrollment criteria consisted of glaucomatous optic neuropathy and VF loss, ≥5 reliable VFs, ≥2 years of follow-up, and polysomnography (PSG) within 12 months of final VF. PSG parameters including apnea-hypopnea index (AHI) and oxygen saturation (SpO2) were collected. Eyes were classified as "progressors" or "nonprogressors" based upon event analysis using Glaucoma Progression Analysis criteria. Two-tailed t test comparisons were performed, and correlations between rates of VF loss and PSG parameters were assessed. RESULTS A total of 141 patients with OSAS and glaucoma were identified. Twenty-five patients (age 67.9±7.6 y) with OSAS (8 mild, 8 moderate, 9 severe) were enrolled. Eleven eyes (44%) were classified as progressors, and had more severe baseline VF loss (P=0.03). Progressors and nonprogressors had nonsignificantly different (P>0.05) age (69.9±8.7 vs. 66.4±6.6 y), follow-up (4.4±0.7 vs. 4.3±1.0 y), intraocular pressure (13.1±2.8 vs. 14.9±2.5 mm Hg), mean ocular perfusion pressure (49.7±5.5 vs. 48.8±9.0 mm Hg), AHI (31.3±18.6 vs. 26.4±24.0), body-mass index (27.8±5.5 vs. 28.8±5.6), and SpO2 (94.1±1.6% vs. 94.0±1.6%). AHI was not correlated with slopes of VF mean deviation (r, -0.271; P, 0.190) or pattern standard deviation (r, 0.211; P, 0.312), and no substantial increase in risk of progression was found with increase in AHI. CONCLUSIONS This study does not support a relationship between OSAS and glaucomatous progression. No correlation was observed between OSAS severity and rate of VF loss.
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7
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Fingeret M, Gaddie IB, Bloomenstein M. Latanoprostene bunod ophthalmic solution 0.024%: a new treatment option for open-angle glaucoma and ocular hypertension. Clin Exp Optom 2019; 102:541-550. [PMID: 30614563 PMCID: PMC6899723 DOI: 10.1111/cxo.12853] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 01/09/2023] Open
Abstract
Latanoprostene bunod (LBN) ophthalmic solution 0.024% is a novel, once‐daily, nitric oxide‐donating prostaglandin analogue for the lowering of intraocular pressure (IOP) in patients with open‐angle glaucoma and ocular hypertension. The IOP‐lowering actions of LBN are mediated by dual mechanisms of the molecule for increasing aqueous humour outflow. The prostaglandin analogue moiety (latanoprost acid) increases uveoscleral outflow, whereas nitric oxide, released by the nitric oxide‐donating moiety (butanediol mononitrate), increases outflow through the trabecular meshwork and the Schlemm's canal. The clinical efficacy and safety of LBN 0.024% in patients with open‐angle glaucoma or ocular hypertension were established in two similarly designed, double‐masked, pivotal phase 3 studies, APOLLO and LUNAR, the pooled three‐month efficacy phase of which demonstrated significantly greater IOP‐lowering of once‐daily LBN 0.024% over twice‐daily timolol 0.5% at all time points. Additional support for the IOP‐lowering effects of LBN 0.024% was provided by two phase 2 studies in patients with open‐angle glaucoma or ocular hypertension (a dose ranging study versus latanoprost and a 24‐hour IOP crossover study versus timolol) and a phase 1 study of healthy volunteers with IOP in the normal range. In addition, long‐term efficacy and safety were demonstrated in the open‐label safety‐extension phases of the phase 3 pivotal studies and a phase 3 52‐week open‐label study of patients with open‐angle glaucoma (including normal‐tension glaucoma) or ocular hypertension. In conclusion, LBN 0.024% has demonstrated both short‐term and long‐term IOP‐lowering efficacy in patients with open‐angle glaucoma or ocular hypertension, including in healthy volunteers and patients with IOP in the normal range, without apparent clinically‐limiting safety or tolerability concerns.
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Affiliation(s)
- Murray Fingeret
- VA New York Harbor Health Care System, Brooklyn and St. Albans Campus, Queens, New York, USA
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8
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Sawada Y, Araie M, Kasuga H, Ishikawa M, Iwata T, Murata K, Yoshitomi T. Focal Lamina Cribrosa Defect in Myopic Eyes With Nonprogressive Glaucomatous Visual Field Defect. Am J Ophthalmol 2018; 190:34-49. [PMID: 29559412 DOI: 10.1016/j.ajo.2018.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate focal lamina cribrosa (LC) defect that spatially correspond to the nonprogressive glaucomatous visual field defect (VFD) in myopic subjects. DESIGN Case-control study. SUBJECTS We included 159 myopic eyes with glaucomatous VFD under treatment and followed up for 7 years. METHODS Serial enhanced-depth imaging spectral-domain optical coherence tomography B-scans of the optic discs were acquired at the end of the follow-up and reviewed for the LC defect. Nonprogressive VFD was defined as having ≤1 progressing point of Humphrey visual field, with a slope calculated using pointwise linear regression worse than -1.0 dB/year at P < .01. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated. RESULTS Sixty-four subjects (40.3%) exhibited nonprogressive VFD with mean deviation change -0.06 ± 0.22 dB/year. Multivariate logistic regression analysis revealed that presence of LC defect was significantly associated with nonprogressive VFD (odds ratio, 3.96; P = .002). The location of LC defect corresponded spatially to the location of VFD. Nonprogressive eyes with LC defect exhibited lower baseline intraocular pressure (IOP) (16.6 mm Hg vs 21.0 mm Hg, P = .0030) and smaller percentage of IOP change (12.9% vs 30.5%, P < .0001) than those without LC defect, but greater myopic optic disc deformation (10.1 degrees vs 1.2 degrees in torsion angle, P < .0001). When the eyes with LC defect had higher baseline IOP, they exhibited progressive VFD. CONCLUSIONS In myopic eyes, there are specific patters of LC defect that are suggested to be associated with nonprogressive glaucomatous VFD.
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Affiliation(s)
- Yu Sawada
- Department of Ophthalmology, Akita University Graduate School of Medicine, Akita, Japan.
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Hitomi Kasuga
- Department of Ophthalmology, Akita University Graduate School of Medicine, Akita, Japan
| | - Makoto Ishikawa
- Department of Ophthalmology, Akita University Graduate School of Medicine, Akita, Japan
| | - Toyoto Iwata
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsuyuki Murata
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine, Akita, Japan
| | - Takeshi Yoshitomi
- Department of Ophthalmology, Akita University Graduate School of Medicine, Akita, Japan
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9
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Ratnarajan G, Jolly JK, Yusuf IH, Salmon JF. The effect of trabeculectomy surgery on the central visual field in patients with glaucoma using microperimetry and optical coherence tomography. Eye (Lond) 2018; 32:1365-1371. [PMID: 29706620 DOI: 10.1038/s41433-018-0095-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the functional and structural effects of trabeculectomy surgery on patients with advanced glaucoma and central visual field defects in the early post-operative period. METHODS Thirty consecutive adult subjects with advanced glaucoma requiring trabeculectomy surgery and an established visual field defect within 10° of fixation underwent microperimetry (MAIA MP-1, CenterVue, Padova, Italy) and optic disc optical coherence tomography (OCT) imaging (Spectralis, Heidelberg Engineering, Germany) pre-operatively, and 1 month and 3 months following trabeculectomy surgery. Main outcome measures were post-trabeculectomy change in mean threshold on microperimetry and nerve fibre layer thickness on OCT. Fellow eyes were used as controls. RESULTS The mean change in MP average threshold values from pre-operative to post-operative was 0.6 ± 1.9 dB for treated eyes and 0.1 ± 1.3 dB for control eyes (p = 0.14) at 1 month and 0.2 ± 2.3 and -0.3 ± 1.6 dB at 3 months (p = 0.22). Mean change in global nerve fibre layer thickness was -0.6 and -0.5 µm for operated and control eyes, respectively (p = 0.83), at 1 month and 0.8 and -0.4 µm at 3 months (p = 0.88). The kappa agreement for structure-function correlation between OCT and MP was 0.735 (confidence interval 0.59-0.88) (p < 0.005). CONCLUSIONS Central visual function and retinal nerve fibre layer thickness appear to be preserved in glaucoma patients with central visual field defects undergoing trabeculectomy surgery in the early post-operative period. These data may inform glaucoma surgeons considering trabeculectomy surgery in this patient group.
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Affiliation(s)
- Gokulan Ratnarajan
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust and NIHR Biomedical Research Centre, Oxford, UK. .,Corneo-plastic unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.
| | - Jasleen K Jolly
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust and NIHR Biomedical Research Centre, Oxford, UK.,Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
| | - Imran H Yusuf
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust and NIHR Biomedical Research Centre, Oxford, UK.,Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
| | - John F Salmon
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust and NIHR Biomedical Research Centre, Oxford, UK.,Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
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10
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Lazaro C, Garcia-Feijoo J, Castillo A, Perea J, Martinez-Casa JM, Garcia-Sanchez J. Impact of Intraocular Pressure after Filtration Surgery on Visual Field Progression in Primary Open-Angle Glaucoma. Eur J Ophthalmol 2018; 17:357-62. [PMID: 17534816 DOI: 10.1177/112067210701700313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg. METHODS A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21 mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups. RESULTS Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant. CONCLUSIONS Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.
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Affiliation(s)
- C Lazaro
- Hospital Provincial, Toledo, Spain.
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11
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Effectiveness of Single-Digit IOP Targets on Decreasing Global and Localized Visual Field Progression After Filtration Surgery in Eyes With Progressive Normal-Tension Glaucoma. J Glaucoma 2017; 25:408-14. [PMID: 25719235 DOI: 10.1097/ijg.0000000000000240] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the effectiveness of achieving single-digit intraocular pressure (IOP) targets with filtration surgery on decreasing global and localized visual field (VF) progression in eyes with progressive normal-tension glaucoma (NTG). METHODS A retrospective chart review was conducted to identify NTG patients who underwent trabeculectomy with mitomycin C between 2006 and 2010 for progressive VF loss with preoperative IOP≤15 mm Hg during the 12 months before surgery. All eyes had glaucomatous optic neuropathy and progressive VF loss, uncontrolled IOP on maximum therapy, and a minimum of 2 baseline preoperative and 4 postoperative VF examinations. VF progression was assessed using Guided Progression Analysis (GPA) and Progressor software. RESULTS Fifteen eyes of 14 patients (mean age 71.8±7.5 y) were enrolled with mean follow-up of 71±26 months. Mean postoperative IOP (8.5±3.5 mm Hg) was significantly (P<0.001) reduced compared with preoperatively (13.1±1.5 mm Hg). The probability of achieving an IOP goal ≤10 mm Hg was 66% at 4 years' follow-up. The overall rate of postoperative VF progression using any method was 13.3% (1 eye using Progressor; 1 eye using GPA and Progressor). Average postoperative slope of MD (-0.25±0.86 dB/y) and pattern SD (0.49±0.83 dB/y) were improved (P=0.05 and 0.07) compared with the preoperative slopes (-1.05±0.66 and 1.21±0.71 dB/y). CONCLUSIONS Achieving single-digit IOP targets with filtration surgery has a beneficial effect on reducing global and localized rates of VF progression in NTG eyes with progression at low IOP.
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12
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Naito T, Fujiwara M, Miki T, Araki R, Fujiwara A, Shiode Y, Morizane Y, Nagayama M, Shiraga F. Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure < 15 mmHg. PLoS One 2017; 12:e0184096. [PMID: 28850613 PMCID: PMC5574552 DOI: 10.1371/journal.pone.0184096] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022] Open
Abstract
We examined the effectiveness of trabeculectomy in decreasing the slope of mean deviation (MD) in Japanese patients with progressive normal-tension glaucoma (NTG) at low intraocular pressure (IOP) levels. The charts of patients who had undergone initial trabeculectomy with adjunctive mitomycin C for progressive NTG with medically controlled IOP < 15 mmHg in 2010–2013 were retrospectively reviewed. Seventeen eyes of 13 NTG patients who had undergone at least 5 times of visual field (VF) examinations in both of preoperatively and postoperatively with postoperative follow-up of ≥ 2 years were enrolled. Preoperative and postoperative MD slopes were compared to evaluate the effectiveness of trabeculectomy in slowing progression of VF. Mean IOP (8.1 ± 2.9 mmHg) and number of IOP-lowering medications (0.8 ± 1.5) were significantly lower postoperatively than preoperatively (13.9 ± 0.9 mmHg; P < 0.001 and 3.0± 0.4; P < 0.0001). In total, 91.7% of eyes with single-digit IOP postoperatively showed improvement in MD slope, whereas only 20.0% of eyes with IOP ≥ 10 mmHg postoperatively showed the improvement. Three eyes (17.6%) showed a decrease in visual acuity (VA) of ≥ 0.1 unit; this group had a lower mean postoperative IOP (6.0 ± 1.0 vs. 8.6 ± 3.0 mmHg; P = 0.1717) and a higher mean IOP reduction rate (56.2 vs. 38.5%; P = 0.8296) than eyes with a VA decrease of < 0.1 unit or no change. Thus, in this analysis of Japanese NTG patients with medically controlled IOP < 15 mmHg, achieving an IOP < 10 mmHg with trabeculectomy was beneficial for reducing the VF progression rate in progressive NTG at low IOP levels. However, an IOP < 7 mmHg by surgery would be required careful attention to VA decline.
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Affiliation(s)
- Tomoko Naito
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
- * E-mail:
| | - Miyuki Fujiwara
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Takako Miki
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Ryoichi Araki
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | | | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
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Dong Z, Shinmei Y, Dong Y, Inafuku S, Fukuhara J, Ando R, Kitaichi N, Kanda A, Tanaka K, Noda K, Harada T, Chin S, Ishida S. Effect of geranylgeranylacetone on the protection of retinal ganglion cells in a mouse model of normal tension glaucoma. Heliyon 2016; 2:e00191. [PMID: 27861646 PMCID: PMC5103079 DOI: 10.1016/j.heliyon.2016.e00191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 09/28/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
Glaucoma is characterized by axonal degeneration of retinal ganglion cells (RGCs) and apoptotic death of their cell bodies, and lowering intraocular pressure is associated with an attenuation of progressive optic nerve damage. Nevertheless, intraocular pressure (IOP) reduction alone was not enough to inhibit the progression of disease, which suggests the contribution of other factors to the glaucoma pathogenesis. In this study, we investigated the cytoprotective effect of geranylgeranylacetone (GGA) on RGCs degeneration using a normal tension glaucoma (NTG) mouse model, which lacks glutamate/aspartate transporter (GLAST) and demonstrates spontaneous RGC and optic nerve degeneration without elevated intraocular pressure (IOP). Three-week-old GLAST+/− mice were given oral administration of GGA at 100, 300, or 600 mg/kg/day or vehicle alone, and littermate control mice were given vehicle alone for 14 days, respectively. At 5 weeks after birth, the number of RGCs was counted in paraffin sections of retinal tissues stained with hematoxylin and eosin. In addition, retrograde labeling technique was also used to quantify the number of RGC. Expression and localization of heat shock protein 70 (HSP70) in retinas were evaluated by reverse transcription polymerase chain reaction and immunohistochemistry, respectively. Activities of caspase-9 and -3 in retinas were also assessed. The number of RGCs of GLAST+/− mice significantly decreased, as compared to that of control mice. RGC loss was significantly suppressed by administration of GGA at 600 mg/kg/day, compared with vehicle alone. Following GGA administration, HSP70 was significantly upregulated together with reduction in the activities of caspase-9 and -3. Our studies highlight HSP70 induction in the retina is available to suppress RGC degeneration, and thus GGA may be applicable for NTG as a promising therapy.
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Affiliation(s)
- Zhenyu Dong
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuhiro Shinmei
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoko Dong
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Saori Inafuku
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Junichi Fukuhara
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryo Ando
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Atsuhiro Kanda
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kohichi Tanaka
- Laboratory of Molecular Neuroscience, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kousuke Noda
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takayuki Harada
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Visual Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shinki Chin
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Laboratory of Ocular Cell Biology and Visual Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Kawase K, Vittitow JL, Weinreb RN, Araie M. Long-term Safety and Efficacy of Latanoprostene Bunod 0.024% in Japanese Subjects with Open-Angle Glaucoma or Ocular Hypertension: The JUPITER Study. Adv Ther 2016; 33:1612-27. [PMID: 27457469 PMCID: PMC5020123 DOI: 10.1007/s12325-016-0385-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Latanoprostene bunod (LBN) is a novel nitric oxide (NO)-donating prostaglandin F2α analog. We evaluated the long-term safety and intraocular pressure (IOP)-lowering efficacy of LBN ophthalmic solution 0.024% over 1 year in Japanese subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). METHODS This was a single-arm, multicenter, open-label, clinical study. Subjects aged 20 years and older with a diagnosis of OAG or OHT instilled 1 drop of LBN ophthalmic solution 0.024% in the affected eye(s) once daily in the evening for 52 weeks and were evaluated every 4 weeks. Safety assessments included vital signs, comprehensive ophthalmic exams, and treatment-emergent adverse events (AEs). Absolute and percent reductions from baseline in IOP were also determined. RESULTS Of 130 subjects enrolled, 121 (93.1%) completed the study. Mean age was 62.5 years, and mean (standard deviation) baseline IOP was 19.6 (2.9) and 18.7 (2.6) mmHg in study eyes and treated fellow eyes, respectively. Overall, 76/130 (58.5%) and 78/126 (61.9%) subjects experienced ≥1 AEs in study eyes and treated fellow eyes, respectively. In both study eyes and treated fellow eyes, the most common AEs were conjunctival hyperemia, growth of eyelashes, eye irritation, and eye pain. At 52 weeks, 9% of treated eyes had an increase in iris pigmentation compared with baseline based on iris photographs. No safety concerns emerged based on vital signs or other ocular assessments. Mean reductions from baseline in IOP of 22.0% and 19.5% were achieved by week 4 in study and treated fellow eyes, respectively. These reductions were maintained through week 52 (P < 0.001 vs. baseline at all visits). CONCLUSION Once daily LBN ophthalmic solution 0.024% was safe and well-tolerated in Japanese subjects with OAG or OHT when used for up to 1 year. Long-term treatment with LBN ophthalmic solution 0.024% provided significant and sustained IOP reduction. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01895972. FUNDING Bausch & Lomb, Inc. a division of Valeant Pharmaceuticals International Inc.
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Affiliation(s)
| | | | - Robert N Weinreb
- Department of Ophthalmology and Shiley Eye Institute, Hamilton Glaucoma Center, University of California San Diego, La Jolla, CA, USA
| | - Makoto Araie
- Kanto Central Hospital of The Mutual Aid Association of Public School Teachers, Tokyo, Japan
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Safety And Efficacy Of Achieving Single-Digit Intraocular Pressure Targets With Filtration Surgery In Eyes With Progressive Normal-Tension Glaucoma. J Glaucoma 2016; 25:217-22. [PMID: 25264998 DOI: 10.1097/ijg.0000000000000145] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Whereas achieving intraocular pressure (IOP) targets ≤ 10 mm Hg typically requires surgical intervention, we sought to examine the safety and efficacy of trabeculectomy in normal-tension glaucoma (NTG). METHODS Patients with progressive NTG undergoing trabeculectomy with preoperative IOP ≤ 15 mm Hg during the 12-month period before surgery were identified at a single academic institution. Failure was defined as IOP reduction <20% below baseline (criteria A), <30% (criteria B), or <40% (criteria C), reoperation for glaucoma, or loss of light perception vision. RESULTS Thirty eyes of 28 patients (mean age, 73 ± 8.7 y) were enrolled with a mean follow-up period of 50 ± 31 months. Mean postoperative IOP (8.6 ± 2.9 mm Hg) and medications (0.6 ± 1.0) at final follow-up was significantly (P<0.001) reduced compared with before surgery (13.2 ± 1.4 mm Hg and 2.5 ± 1.2, respectively). The cumulative probability of failure during 5 years of follow-up was 32% (criteria A), 48%, (criteria B), and 67% (criteria C). The probability of successfully achieving an IOP goal ≤ 10 mm Hg was 68% at 4 years of follow-up. CONCLUSIONS Trabeculectomy is a safe and effective method for achieving single-digit IOP targets in NTG eyes with progression at low IOP.
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Evaluation of the Effect of Latanoprostene Bunod Ophthalmic Solution, 0.024% in Lowering Intraocular Pressure over 24 h in Healthy Japanese Subjects. Adv Ther 2015; 32:1128-39. [PMID: 26563323 PMCID: PMC4662725 DOI: 10.1007/s12325-015-0260-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 01/13/2023]
Abstract
Introduction Latanoprostene bunod is a novel nitric oxide (NO)-donating prostaglandin F2α receptor agonist in clinical development for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. We evaluated the effect of latanoprostene bunod 0.024% instilled once daily (QD) on lowering IOP over a 24-h period in healthy Japanese subjects following 14 days of treatment. Methods This was a single-arm, single-center, open-label clinical study of 24 healthy Japanese male volunteers. A baseline IOP profile was established in both eyes in the sitting position at 8 PM, 10 PM, 12 AM, 2 AM, 4 AM, 8 AM, 10 AM, 12 PM, and 4 PM using a Goldmann applanation tonometer. Subjects subsequently instilled latanoprostene bunod 0.024% QD at 8 PM for 14 days in both eyes. The absolute and change from baseline in sitting IOP was assessed on day 14. Results The mean (SD) age of the subjects was 26.8 (6.3) years, and mean (SD) baseline IOP was 13.6 (1.3) mmHg in the study eye. Latanoprostene bunod 0.024% instilled QD for 14 days reduced IOP at all the evaluated time points (P < 0.001) with a mean (SD) 24-h reduction of 3.6 (0.8) mmHg or 27% from the baseline in the study eye. Peak and trough IOP lowering occurred at 8 AM and 8 PM (12 and 24 h following instillation) with a mean reduction of 4.2 (1.8) mmHg, or 30%, and 2.8 (2.2) mmHg, or 20%, respectively. Punctate keratitis and ocular hyperemia, both mild in severity, were the most common adverse events. Conclusion Latanoprostene bunod ophthalmic solution 0.024%, dosed QD for 14 days, significantly lowered mean IOP in healthy Japanese subjects during the entire 24-h period. Studies of latanoprostene bunod in patients diagnosed with normal tension glaucoma are warranted. Trial Registration Clinicaltrials.gov identifier NCT01895985. Funding Bausch & Lomb, Inc. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0260-y) contains supplementary material, which is available to authorized users.
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Rafuse PE. The optimal trabeculectomy: patient and procedure. Can J Ophthalmol 2014; 49:523-7. [PMID: 25433742 DOI: 10.1016/j.jcjo.2014.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 08/03/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
Guarded external fistulization procedures remain important surgical options for patients who are experiencing progressive vision loss caused by glaucoma. The progenitor procedure, the trabeculectomy, has undergone continuous modifications over the past 40 or more years, rendering the surgery safer and the outcomes more predictable. Studies are cumulating to show that very low intraocular pressures can both reduce glaucomatous vision loss and positively change the rate of progression. Optimal patient selection and patient preparation, as well as some guiding procedural principles, are described in this review.
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Affiliation(s)
- Paul E Rafuse
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, N.S..
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18
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Mataki N, Murata H, Sawada A, Yamamoto T, Shigeeda T, Araie M. Visual Field Progressive Rate in Normal Tension Glaucoma Before and After Trabeculectomy: A Subfield-Based Analysis. Asia Pac J Ophthalmol (Phila) 2014; 3:263-6. [PMID: 26107911 DOI: 10.1097/apo.0000000000000020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare pretrabeculectomy and posttrabeculectomy progression rates in normal-tension glaucoma in 6 subfields of the central 30 visual field. DESIGN A retrospective study. METHODS Clinical records of 34 patients with normal-tension glaucoma (12 males and 22 females) with progressive visual field loss undergoing successful trabeculectomy were studied. The time course of the mean deviation (MD) and mean of total deviation in the superior/inferior arcuate, paracentral, and cecocentral subfields were analyzed using a linear mixed-effects model. RESULTS Patients' age, intraocular pressure (IOP), MD, and pretrabeculectomy and posttrabeculectomy follow-up averaged 57.7 ± 9.6 years, 15.7 ± 1.7 mm Hg, -12.7 ± 5.5 dB, and 4.6 ± 1.5 and 5.7 ± 1.2 years, respectively. Average IOP was lowered by 6.1 ± 3.3 to 10.3 ± 2.7 mm Hg (5-14 mm Hg) over the postoprerative period with MD change rate of -0.25 dB/y (P < 0.003), which was slower (P < 0.001) than the preoperative one (-0.70 dB/y). The preoperative mean of total deviation change rate (-0.31 to -1.35 dB/y) improved postoperatively in the superior and inferior paracentral subfields (P < 0.001), whereas it remained unchanged in the inferior cecocentral/arcuate subfields (P > 0.10). The postoperative rate of progression showed no significant variation in these subfields. CONCLUSIONS The rate of progression significantly varied among the 6 subfields preoperatively. It was significantly slowed down in the superior subfields by surgical IOP reduction, but not in the inferior cecocentral/arcuate subfields.
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Affiliation(s)
- Naomi Mataki
- From the *Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, and †Division of Ophthalmology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo; and ‡Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
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The impact of surgical intraocular pressure reduction on visual function using various criteria to define visual field progression. J Glaucoma 2014; 22:632-7. [PMID: 22525124 DOI: 10.1097/ijg.0b013e3182567cfc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the impact of surgical intraocular pressure (IOP) reduction on visual function using various methods to define visual field (VF) progression. METHODS A retrospective chart review was conducted on consecutive glaucoma patients who underwent surgical IOP reduction between January 1, 2002 and December 31, 2007. All subjects had glaucomatous optic neuropathy, a minimum of 5 preoperative and 5 postoperative VFs, and were followed for a minimum of 2 years both before and after surgery. VF progression was determined using guided progression analysis, linear regression analysis of the visual field index, and individual sensitivity values using Progressor software. RESULTS Seventeen eyes of 17 patients (mean age 77.9±9.9 y) were enrolled. Subjects were followed for a mean 5.8±2.4 years before surgery and 4.5±1.5 years after surgery. The mean postoperative IOP (11.3±4.2 mm Hg) and medications (1.3±1.3) were significantly (P<0.001 and P=0.01) reduced compared with before surgery (18.0±3.9 mm Hg, 2.4±0.9, respectively). The number of eyes judged to have VF progression using any method during the postoperative period (3 of 17, 17.6%) was significantly (P=0.03) reduced compared with the preoperative period (9 of 17 eyes, 52.9%). Using visual field index criteria, 8 eyes were judged to have preoperative VF progression and 1 eye had persistent VF progression during the postoperative period. None of the eyes judged to have preoperative VF progression using Early Manifest Glaucoma Trial (n=4) and Progressor criteria (n=1) demonstrated persistent VF progression during the postoperative period. Among eyes with preoperative VF progression, the postoperative slope of mean deviation (-0.21±0.23 dB/y) was significantly (P=0.03) reduced compared with before surgery (-1.01±0.23 dB/y). CONCLUSIONS Despite differences in the criteria used to define VF progression, glaucoma surgical IOP reduction significantly reduces the incidence and rate of VF progression.
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Shum JW, Leung D. Surgical Decisions in Primary Open Angle Glaucoma with Low or Normal Tension. J Curr Glaucoma Pract 2013; 7:121-7. [PMID: 26997795 PMCID: PMC4741152 DOI: 10.5005/jp-journals-10008-1149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 06/29/2013] [Indexed: 11/23/2022] Open
Abstract
Glaucoma, given its insidious nature, is often coined 'the sneak thief of sight'. Following this trail of thought, primary open angle glaucoma with low or normal tension (POAGLNT) could be coined 'the king of thieves'. The lack of a compelling red fag of high intraocular pressure (IOP), together with the diurnal fuctuation of the deceptively low baseline IOP, POAGLNT poses a therapeutic challenge in terms of judging when to intervene, and how. In this review article, we will outline the considerations before undergoing surgery: risk stratification, defining goal in terms of target pressure and IOP modulation. We will also review the strengths, weaknesses and pearls of available options. How to cite this article: Shum JW, Leung DY. Surgical Decisions in Primary Open Angle Glaucoma with Low or Normal Tension. J Current Glau Prac 2013;7(3):121-127.
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Affiliation(s)
- J W Shum
- Department of Ophthalmology, The Eye Institute, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Dy Leung
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital; Department of Ophthalmology and Visual Sciences Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong
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Fukuoka S, Amano S, Honda N, Mimura T, Usui T, Araie M. Effect of trabeculectomy on ocular and corneal higher order aberrations. Jpn J Ophthalmol 2011; 55:460-466. [PMID: 21773749 DOI: 10.1007/s10384-011-0063-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the effect of trabeculectomy on ocular and corneal higher order wavefront aberrations. METHODS Trabeculectomy with a limbal-based conjunctival flap was performed in 13 patients (13 eyes). Ocular and corneal higher order aberrations were measured using a wavefront analyzer before and after surgery. The higher order aberrations for a 4-mm pupil diameter were expanded into Zernike's polynomials. Coma aberration, spherical aberration, and total higher order aberrations were evaluated as root mean square values. RESULTS Mean intraocular pressure was significantly reduced from 15.5 ± 3.1 mmHg preoperatively to 7.5 ± 3.5 and 7.2 ± 4.4 mmHg at 1 and 3 months after surgery, respectively. The mean spherical equivalent refractive error was not changed by the surgery. Mean vector powers for surgically induced refractive changes at 1 and 3 months postoperatively were 1.29 ± 0.69 and 1.30 ± 0.89 diopters, respectively. Corneal coma-like, spherical-like, and total higher order aberrations were not significantly changed by surgery. Trabeculectomy significantly increased ocular coma-like (P = 0.0021) and total (P = 0.0019) higher-order aberrations at 1 month, but not at 3 months postoperatively. CONCLUSION Ocular coma-like and total aberrations were significantly increased at 1 month after trabeculectomy with a limbal-based conjunctival flap, but they had returned to normal levels by 3 months.
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Affiliation(s)
- Shima Fukuoka
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shiro Amano
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Norihiko Honda
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Mimura
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomohiko Usui
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Makoto Araie
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Cho SW, Kim JM, Park KH, Choi CY. Effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy for glaucoma. Jpn J Ophthalmol 2010; 54:407-13. [PMID: 21052902 DOI: 10.1007/s10384-010-0855-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy in the treatment of patients with glaucoma. METHODS To measure the main treatment effects of a fixed combination of brimonidine 0.2%-timolol 0.5%, we conducted three small studies: (1) a comparison of diurnal intraocular pressure (IOP) at baseline and at 6 months after brimonidine/timolol fixed-combination therapy (n = 81); (2) an assessment of the effects of one drop of the brimonidine/timolol fixed combination on diurnal IOP (n = 25); and (3) the effects of brimonidine/timolol fixed-combination therapy on the anterior ocular segment over time (n = 64). RESULTS (1) After 6 months of treatment with the brimonidine/timolol fixed combination, the mean diurnal IOP in primary open-angle glaucoma (POAG) decreased from 21.4 ± 2.0 to 14.5 ± 3.1 mmHg (32.2%, P < 0.001), and the mean diurnal IOP in normal-tension glaucoma (NTG) decreased from 13.5 ± 2.8 to 10.9 ± 2.0 mmHg (19.3%, P < 0.001). (2) After instillation with one drop of the brimonidine/timolol fixed combination, the IOP in the instilled eye was lowest at 9:00 p.m. and had decreased by 1.7 mmHg compared with the baseline IOP in the instilled eye. The difference in IOP between the instilled eye and untreated fellow eye was largest at 3:00 p.m., measuring 1.7 mmHg (P = 0.011). (3) Brimonidine/timolol fixed-combination therapy caused significant miosis over time (P = 0.003). CONCLUSIONS The results of this study suggest that brimonidine/timolol fixed-combination therapy has beneficial IOP-lowering effects and significant effects on pupil size.
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Affiliation(s)
- Sung Woo Cho
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Folgar FA, de Moraes CGV, Prata TS, Teng CC, Tello C, Ritch R, Liebmann JM. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol 2010; 149:258-264.e2. [PMID: 20103054 DOI: 10.1016/j.ajo.2009.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Incisional glaucoma surgical procedures produce greater intraocular pressure (IOP) reduction and less IOP variability than medical treatment. We sought to determine the efficacy of glaucoma surgery in decreasing localized and global rates of visual field (VF) progression. DESIGN Retrospective, interventional case series. METHODS Subjects in the New York Glaucoma Progression Study with glaucomatous optic neuropathy, repeatable VF loss, and 10 or more Swedish interactive threshold algorithm standard VF examinations were assessed for eligibility. Patients who underwent successful glaucoma surgery (not requiring further surgical intervention and IOP < 18 mm Hg) in either eye and who were followed up for at least 2 years before and after surgery were enrolled. Automated pointwise linear regression analysis was used to calculate global and localized rates of progression before and after surgery. Eyes with other ocular conditions likely to affect the VF and an insufficient number of VF to create a slope before and after surgery were excluded. Comparisons were performed within the same eyes before and after surgery (Student paired t test). RESULTS We enrolled 28 eyes of 28 patients (mean age, 61.2 +/- 14.5 years). The mean number +/- standard deviation of VF was 13.4 +/- 2.3, spanning 7.1 +/- 1.2 years (range, 4 to 9 years). Mean IOP +/- standard deviation decreased from 19.0 +/- 3.9 mm Hg before surgery to 11.3 +/- 3.7 mm Hg after surgery (40% reduction; P < .01). Mean global progression rates decreased from -1.48 +/- 1.4 dB/year before surgery to -0.43 +/- 0.8 dB/year after surgery (70% reduction; P = .01). Twelve eyes (42.8%) had at least 1 significantly progressing point before surgery, whereas only 2 (7.1%) had at least 1 progressing point after surgery. Each 1 mm Hg of IOP reduction after surgery resulted in a 0.1 dB/year decrease in the global rate of progression. CONCLUSIONS Successful IOP reduction after glaucoma surgery greatly reduces both the number of progressing points and the localized and general rates of VF progression.
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Hitchings RA. Normal-Tension Glaucoma. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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A Placebo-Controlled 3-Year Study of a Calcium Blocker on Visual Field and Ocular Circulation in Glaucoma with Low-Normal Pressure. Ophthalmology 2008; 115:2049-57. [DOI: 10.1016/j.ophtha.2008.05.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 04/14/2008] [Accepted: 05/06/2008] [Indexed: 11/15/2022] Open
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Ikeda Y, Mori K, Ishibashi T, Naruse S, Nakajima N, Kinoshita S. Effects of Switching from Topical β-Blockers to Latanoprost on Intraocular Pressure in Patients with Normal-Tension Glaucoma. J Ocul Pharmacol Ther 2008; 24:230-4. [DOI: 10.1089/jop.2007.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Ishibashi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeta Naruse
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Nakamoto K, Yasuda N. Effect of Concomitant Use of Latanoprost and Brinzolamide on 24-hour Variation of IOP in Normal-tension Glaucoma. J Glaucoma 2007; 16:352-7. [PMID: 17570997 DOI: 10.1097/ijg.0b013e318033b491] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the effect of the concomitant use of latanoprost and brinzolamide on the 24-hour variation in the intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). METHODS We studied a total of 44 eyes from 22 NTG patients. Mean 24-hour IOP variation was determined after a washout period of > or =4 weeks. Latanoprost monotherapy was continued in both eyes for 8 weeks. Thereafter, patients were randomized to continue latanoprost monotherapy in 1 eye whereas brinzolamide was added as an adjunct to latanoprost therapy in the other eye. Eight weeks after the initiation of brinzolamide treatment, the 24-hour IOP variation was remeasured. IOP was measured in the sitting position 8 times daily using a Goldmann applanation tonometer before and after treatment. RESULTS The eyes treated with latanoprost monotherapy and those treated with latanoprost and brinzolamide showed a significant decrease in IOP at all time points. Percent reductions in the diurnal mean IOP (mean IOP at 10 AM, 1 PM, and 4 PM) and in nocturnal mean IOP (mean IOP at 10 PM, 1 AM, and 3 AM) were significantly greater in the eyes treated with the combination of latanoprost and brinzolamide than those with latanoprost alone (diurnal mean IOP: latanoprost and brinzolamide=19.8%, latanoprost=14.1%, P<0.001; nocturnal mean IOP: latanoprost and brinzolamide=13.4%, latanoprost=10.0%, P<0.05). CONCLUSIONS For the treatment of NTG, the combination of latanoprost and brinzolamide demonstrated additive effects in lowering IOP, not only during the day, but also at night.
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Ishibashi S, Hirose N, Tawara A, Kubota T. Effect of Latanoprost on the Diurnal Variations in the Intraocular and Ocular Perfusion Pressure in Normal Tension Glaucoma. J Glaucoma 2006; 15:354-7. [PMID: 16988595 DOI: 10.1097/01.ijg.0000212264.96864.3e] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of latanoprost on the diurnal variations in the intraocular pressure (IOP) combined with the ocular perfusion pressure (OPP) in patients with normal tension glaucoma (NTG). PATIENTS AND METHODS Twenty-two eyes from 22 patients with NTG were used for the study. The diurnal variations in the IOP and blood pressure (BP) were measured every 3 hours without therapy, and then the patients were treated with latanoprost (0.005%) once daily for more than 12 weeks. The diurnal variations in the IOP and BP under medication were again measured every 6 hours. The diurnal variation of IOP for 24 hours, mean diurnal IOP, maximum IOP, minimum IOP, range of variation in IOP, OPP, and BP were compared between the baseline and after treatment by means of a paired t test. RESULTS At 3 months after the start of the latanoprost treatment regimen, the IOP showed a statistically significant decrease at every assessed time point over 24 hours (P<0.001). Latanoprost significantly reduced the mean diurnal IOP, maximum IOP, minimum IOP, and mean range of variation in the IOP values from baseline (P<0.001, <0.001, <0.001, and 0.009, respectively). OPP after treatment showed no significant difference at any assessed time points from the baseline (P>0.1). Latanoprost did not significantly alter the mean diurnal OPP (P>0.1), and BP (P>0.5) from the baseline. CONCLUSIONS Latanoprost was thus found to significantly reduce IOP over 24 hours, whereas it does not affect OPP and BP in NTG patients. Therefore, it may be a useful medication for NTG.
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Affiliation(s)
- Shingo Ishibashi
- Department of Ophthalmology, School of Medicine, University of Occupational and Environmental Health , Kitakyushu, Japan.
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Nakagami T, Yamazaki Y, Hayamizu F. Prognostic factors for progression of visual field damage in patients with normal-tension glaucoma. Jpn J Ophthalmol 2006; 50:38-43. [PMID: 16453186 DOI: 10.1007/s10384-005-0273-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 05/30/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG). METHODS Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of -6 dB or better, moderately damaged eyes with MD between -6 dB and -12 dB, and severely damaged eyes with MD of -12 dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model. RESULTS The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage. CONCLUSIONS The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG.
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Affiliation(s)
- Takako Nakagami
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan.
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Ikeda Y, Mori K, Ishibashi T, Naruse S, Nakajima N, Kinoshita S. Latanoprost Nonresponders with Open-Angle Glaucoma in the Japanese Population. Jpn J Ophthalmol 2006; 50:153-7. [PMID: 16604392 DOI: 10.1007/s10384-005-0293-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 08/11/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE As some patients show little response to latanoprost, one of the most powerful topical glaucoma medications, we investigated the incidence and clinical profiles of latanoprost nonresponders (LNR) in the Japanese population. METHODS We examined 62 glaucoma patients (62 eyes) who had received only latanoprost for more than 3 months. Their mean age was 63.8 +/- 1.8 years; the mean observation period was 9.7 +/- 0.4 months. At 1, 3, 6, and 12 months, their intraocular pressure (IOP) was measured, and the IOP reduction rate (RR) and the rate of LNR, defined as RR of 10% or less, were calculated. We statistically analyzed clinical factors involved in the LNR status of our study population. RESULTS At 1, 3, 6, and 12 months, RR was 20.1 +/- 2.0%, 18.8 +/- 2.3%, 21.1 +/- 2.8%, and 23.0 +/- 2.6%, respectively. At the same time points, the LNR incidence was 23.1%, 28.1%, 23.5%, and 31.8%, respectively, and significantly higher in patients whose baseline IOP was less than 15 mmHg. Patient sex and age and the glaucoma type played no significant role in the LNR status. CONCLUSIONS The incidence of LNR in the Japanese population, including normal-tension glaucoma (NTG) patients, is higher than among European or American patients. Only low baseline IOP was a significant clinical factor among LNR.
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Affiliation(s)
- Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Orgul S, Zawinka C, Gugleta K, Flammer J. Therapeutic Strategies for Normal-Tension Glaucoma. Ophthalmologica 2005; 219:317-23. [PMID: 16286789 DOI: 10.1159/000088372] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 04/28/2004] [Indexed: 11/19/2022]
Abstract
Treatment of normal-tension glaucoma has been a subject of debate for several years. Glaucomatous damage cannot be influenced directly, and current treatment modalities in normal-tension glaucoma are aimed at the control of risk factors. Intraocular pressure is a widely accepted risk factor and its reduction can improve the prognosis in normal-tension glaucoma patients. The repeated demonstration of the importance of hemodynamic factors in normal-tension glaucoma has, however, not been paralleled by a comparable progress in the development of therapeutic modalities capable of influencing favorably ocular blood flow. Today, calcium channel blockers seem to be the most promising adjunctive treatment to be considered in patients with glaucomatous optic neuropathy without increased intraocular pressure.
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Shigeeda T, Tomidokoro A, Araie M, Koseki N, Yamamoto S. Long-term follow-up of visual field progression after trabeculectomy in progressive normal-tension glaucoma. Ophthalmology 2002; 109:766-70. [PMID: 11927438 DOI: 10.1016/s0161-6420(01)01009-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the long-term effects of trabeculectomy on the progression of visual field damage in patients with progressive normal-tension glaucoma (NTG). DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Twenty-three patients with NTG who had significant progression of visual field damage preoperatively and underwent trabeculectomy using antimetabolites. METHODS Visual field testing using the Humphrey Visual Field Analyzer was periodically performed before and for at least 5 years after surgery (mean, 6 years). The time course of the mean deviation (MD) and mean of total deviations (TD(mean)) in four separate subfields, superior and inferior cecocentral and superior and inferior arcuate fields, were analyzed using a linear mixed effects model. MAIN OUTCOME MEASURES Intraocular pressure (IOP), preoperative and postoperative regression coefficients of the time course of MD or TD(mean) in the four subfields, corresponding to the rate of progression of visual field damage. RESULTS IOP significantly decreased from 16.2 +/- 1.8 mmHg preoperatively to approximately 11 mmHg during the postoperative follow-up period (P < 0.001). The preoperative regression coefficient of MD change was significantly negative (-1.05 [95% confidence interval, -1.28 to -0.82] dB/year, P < 0.001). After surgery, it increased significantly to -0.44 (95% confidence interval, -0.64 to -0.24) dB/year (P < 0.001), but the postoperative value was still significantly negative (P < 0.001). In the superior cecocentral, superior and inferior arcuate fields, preoperative regression coefficients of TD(mean) change were significantly negative (P < 0.001) and significantly increased after surgery (P < 0.01). In the inferior cecocentral field, the preoperative regression coefficient was not significantly different from 0 (P = 0.72) and did not change significantly after surgery (P = 0.15). CONCLUSIONS Trabeculectomy was statistically associated with slowing further progression of visual field damage in patients with progressive NTG. The progression, however, did not completely stop over the 6-year postoperative follow-up period.
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Affiliation(s)
- Takashi Shigeeda
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Membrey WL, Bunce C, Poinoosawmy DP, Fitzke FW, Hitchings RA. Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 Visual field progression. Br J Ophthalmol 2001; 85:696-701. [PMID: 11371491 PMCID: PMC1724011 DOI: 10.1136/bjo.85.6.696] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reduction of intraocular pressure 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. METHOD 61 eyes of 61 white patients with NTG who had undergone a primary guarded fistulising procedure were reviewed. 20 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 slope 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 6 month period for all patients analysed as one group, hazard ratio = -0.021 (p=0.002). There was a statistically significantly 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). CONCLUSION 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.
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Affiliation(s)
- W L Membrey
- Glaucoma Unit, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
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Membrey WL, Poinoosawmy DP, Bunce C, Hitchings RA. Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 1 intraocular pressure control and complications. Br J Ophthalmol 2000; 84:586-90. [PMID: 10837381 PMCID: PMC1723511 DOI: 10.1136/bjo.84.6.586] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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. METHOD 86 eyes of 73 white NTG patients who had undergone a primary guarded fistulising procedure were reviewed. 25 eyes had no antiproliferatives, 36 had peroperative 5-fluorouracil (5-FU) and 25 had peroperative mitomycin C (MMC). Their postoperative IOPs, complications, and changes in visual acuity were recorded. RESULTS Eyes that had no adjunctive antiproliferative less commonly maintained a 20-30% reduction in IOP (47.4% at 2 years) compared with either the 5-FU group (69.4%at 2 years, p=0.01) or the MMC group (64.9% at 2 years, p=0.04). Eyes that had adjunctive MMC more often had late hypotony (28%, p=0.02) and late bleb leak (12%, p<0.001). Eyes that had adjunctive MMC also more often had a two lines loss of Snellen visual acuity (39.8% by 2 years) compared with those that had adjunctive 5-FU (14.7% by 2 years), p=0.06. CONCLUSION For NTG patients at low risk of scarring trabeculectomy with adjunctive peroperative 5-FU should maintain a suitable target IOP without the additional sight threatening complications seen with adjunctive MMC.
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Affiliation(s)
- W L Membrey
- Glaucoma Unit, Moorfields Eye Hospital, London, UK
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Viswanathan AC, Hitchings RA. Glaucoma: fielding progressive disease. Eye (Lond) 1998; 12 ( Pt 1):5-6. [PMID: 9614511 DOI: 10.1038/eye.1998.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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