Primer Açık Açılı Glokom ve Psödoeksfoliatif Glokomda, Mitomisin C’li Trabekülektominin Maküler Kalınlık Üzerine Olan Etkisinin Kıyaslanması

Evaluation of Macular Thickness in Glaucoma Patients Using Prostaglandin Analog Eye Drops Undergoing Trabeculectomy with Mitomycin C: Prospective, Comparative, Randomized, Masked Examiner Study

INTRODUCTION

The aim of the study was to evaluate the macular thickness of glaucomatous patients undergoing trabeculectomy (TREC) with mitomycin C (MMC) with or without the use of prostaglandin analog (PA) eye drops.

METHODS

In this prospective, comparative clinical trial, patients with glaucoma and indications for TREC with MMC using PA and without previous macular changes were randomized into 2 groups: the study group (SG) and the control group (CG). In the CG, PA was suspended between 30 and 60 days after the preoperative exams. The subjects were evaluated, including optical coherence tomography (OCT) with the Cirrus 4000 macular protocol preoperatively and in the postoperative period on 3 occasions: 1-3 days ("PO1"), 6-9 days ("PO7"), and 27-30 days ("PO30") after surgery. The results were compared between groups.

RESULTS

Thirty-five eyes of 35 patients were included (17 in the CG and 18 in the SG). There was no statistically significant difference in age (p = 0.2), the preoperative visual field mean deviation (p = 0.08), or the preoperative intraocular pressure (SG: 24.8 ± 7.8 mm Hg vs. CG: 22.8 ± 6.0 mm Hg, p = 0.4). The preoperative macular OCT parameters were equivalent between the groups (p > 0.05). When comparing the variation of parameters between the groups between preop and PO30 there was equivalence in all of the comparisons evaluated. The presence (or absence) of the lens did not affect the results.

CONCLUSION

PA eye drops did not affect macular thickness after TREC with MMC in glaucomatous patients.

Long-term effects of trabeculectomy in primary open-angle glaucoma on segmented macular ganglion cell complex alterations

PURPOSE

The aim of this study is to compare, using optical coherence tomography (OCT), the changes in the thickness of the macular nerve fiber layer (mNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL) and peripapillary global retinal nerve fiber layer (gRNFL) (in a span of 3 years) in surgically treated eyes with primary open-angle glaucoma (POAG).

METHODS

The medical records of 32 consecutive POAG patients who underwent trabeculectomy with mitomycin-C, between January 2013 and December 2014, were retrospectively reviewed. Pre- and postoperative measurements of IOP and OCT were analyzed 1, 2 and 3 years after the operation.

RESULTS

Among all patients, no significant changes in the thickness of the mNFL, mGCL or mIPL were found, with a significant reduction observed only in the IOP values and peripapillary gRNFL thickness during the 3-year postoperative period. In a subgroup analysis based on the preoperative peak IOPs (median value:41 mmHg), the thickness of the mNFL, mGCL and mIPL in the 3-year postoperative period increased significantly in the lower preoperative peak IOP group (IOP < 41 mmHg), whereas the macular OCT parameters in the 3-year postoperative period decreased in the higher preoperative peak IOP group.

CONCLUSIONS

Eyes exhibiting lesser preoperative peak IOP demonstrated greater preservation of the layer-by-layer segmented macular ganglion cell complex thickness as compared to eyes exhibiting greater preoperative peak IOP; also when the IOPs determined for the two groups in the period of follow-up were quite comparable.