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Successful glaucoma filtering surgery is characterized by the passage of aqueous humor from the anterior chamber to the subconjunctival space, which results in the formation of a filtering bleb. Aqueous in the subconjunctival space may then exit by multiple pathways. Bleb failure most often results from fibroblast proliferation and subconjunctival fibrosis. Factors associated with an increased risk of bleb failure include youth, aphakia, active anterior segment neovascularization, inflammation, previously failed glaucoma filtering surgery, and, possibly, race. Several surgical and pharmacologic techniques have recently been introduced to enhance success in eyes with poor surgical prognoses. To elucidate the scientific rationale of these methods, we summarize the process of wound healing after glaucoma filtering surgery and describe postoperative clinical and histopathologic features, factors which may affect success, and specific methods to improve surgical success.

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This study determines the relation between visual field impairment, visual functioning, and global quality of life in patients with glaucoma. Binocular visual field impairment was calculated from simultaneous Esterman visual field testing using the Humphrey automated perimeter. Visual acuity impairment, defined with the American Medical Association's Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the field test version of the National Eye Institute-Visual Functioning Questionnaire; and global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey, were determined in 147 consecutive patients with glaucoma. None of the Medical Outcomes Study 36-Item Short Form HealthSurvey domains demonstrated more than a weak correlation with visual field impairment. scores were moderately correlated (r=-0.58). Of the National Eye Institute-Visual Functioning Questionnaire scales, peripheral vision (r=\m=-\0.60), distance activities (r=\m=-\0.56), and vision-specific dependency (r=\m=-\0.56) were moderately correlated with visual field impairment; vision-specific social functioning, near activities, vision-specific role difficulties, general vision, vision-specific mental health, color vision, and driving were modestly correlated with visual field impairment (r value between \m=-\0.32and \m=-\0.55); visual pain was weakly correlated with visual field impairment; and general health and vision\x=req-\ specific expectations were not notably correlated with visual field impairment. Statistically adjusting for visual acuity weakened the correlations. The Medical Outcomes Study 36-Item Short Form Health Survey indicated that our patients with glaucoma were comparable with previously studied patients without severe systemic medical problems. However, the Medical Outcomes Study 36-Item Short Form Health Survey scores did not correlate with visual field impairment in our study. Based on the moderate correlation between binocular visual field impairment with the VF-14 and the National Eye Institute-Visual Functioning Questionnaire, these questionnaires may be useful among patients with glaucoma.

Purpose: To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.Design: Cohort study.Participants: 3,236 eyes of 1,618 participants. Methods:Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC. Main Outcome Measures:Incidence of optic disc hemorrhages and POAG endpoints.Results: Median follow-up was 96.3 months. Stereophotograph-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants prior to POAG. Twenty one (16%) were detected by both clinical examination and review of photographs and 107 (84%) only by review of photographs (P <0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup/disc ratio, larger PSD index on perimetry, family history of glaucoma, and smoking. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis, (p<0.001; 95% confidence interval 3.6 -10.1), and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (p<0.001; 95% confidence interval 2.1 -6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2% compared to 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage that developed a POAG endpoint, the median time between the two events was 13 months.Corresponding Author: Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136. Telephone 305−326−6384. FAX 305−326−6337. E-mail: dbudenz@med.miami.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion: Review of stereo photographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG endpoint in participants in the OHTS. However, the majority of eyes (86.7%) that developed a disc hemorrhage have not developed a POAG endpoint to date.