Prospective Evaluation of Early Visual Loss Following Glaucoma-filtering Surgery in Eyes With Split Fixation

Balekudaru, Shantha; George, Ronnie; Panday, Manish; Singh, Maneesh; Neog, Aditya; Vijaya, Lingam

doi:10.1097/ijg.0000000000000041

Cited by 14 publications

(14 citation statements)

References 8 publications

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“…In the metaanalysis, based on eight studies, the overall effect size indicated that glaucoma surgery significantly reduces the progression velocity in glaucoma. Several studies reported an unchanged BCVA after glaucoma surgery, for both TE (Bevin et al 2008;Bhardwaj et al 2013;Balekudaru et al 2014;Bertrand et al 2014;Iverson et al 2016) and BGI (Namavari et al 2016), and in a recent randomized clinical trial (RCT) comparing primary BGI with TE (Islamaj et al 2018). This is in agreement with our results.…”

Section: Discussionsupporting

confidence: 93%

“…Only a few earlier studies reported on a surgery-induced MD decline. Most studies found no influence on the MD (Tavares et al 2006;Sehi et al 2010;Yamazaki & Hayamizu 2012;Balekudaru et al 2014;Wright et al 2015;Islamaj et al 2018); one study found a deterioration of the MD after a TE (Hagiwara et al 2000). In the latter study, the postoperative MD was assessed at the end of the follow-up (mean follow-up duration was 4.75 years).…”

Section: Discussionmentioning

confidence: 99%

“…This observation gives the clinician the sense of a drawback of surgery. However, the literature showed all three possible outcomes: an improvement in visual function, a decline and no effect (Hagiwara et al 2000;Sehi et al 2010;Balekudaru et al 2014;Caprioli et al 2016). The crucial question is, if there is a surgery-induced loss, if it counterbalances the loss avoided due to the IOP lowering.…”

Section: Introductionmentioning

confidence: 99%

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Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

Montolio

Müskens

Jansonius

2018

Acta Ophthalmologica

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Purpose To determine the cost (loss of visual function associated with the procedure) and benefit (long‐term preservation of the visual field) of glaucoma surgery. Methods We included 100 patients who underwent glaucoma surgery (Baerveldt glaucoma implant [BGI], n = 61; trabeculectomy [TE], n = 39). Preoperatively, the median (interquartile range [IQR]) standard automated perimetry mean deviation (MD) was −12 (−16 to −6) dB. We analysed the change in visual acuity (BCVA) and MD due to the procedure and, in a subset with at least 5 years of perimetric follow‐up both pre‐ and postoperatively (n = 20), the change in rate of progression (ROP; time rate of change in MD). For the surgery‐induced change in ROP, we also performed a meta‐analysis including the current and previously published studies. From the surgery‐induced decrease in MD and change in ROP, we calculated the average postoperative duration needed for the benefit to surpass the cost. Results Mean (standard deviation) MD decline was 1.3 (2.7) and 1.0 (2.3) dB for BGI (p < 0.001) and TE (p = 0.009), respectively; no significant surgery‐induced changes in BCVA were found (p = 0.08 and p = 0.12, respectively). In our study, surgery was associated with a non‐significant deceleration of ROP (from −0.37 [0.52] to −0.15 [0.48] dB/year; p = 0.23). The meta‐analysis, based on eight studies, showed an overall surgery‐induced change in ROP of 0.44 (95% confidence interval 0.25 to 0.64; p < 0.0001) dB/year. Conclusion Glaucoma surgery significantly reduces the progression velocity in glaucoma. On average, the benefit of glaucoma surgery surpasses the cost after approximately 1.5 years.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

Montolio

Müskens

Jansonius

2018

Acta Ophthalmologica

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“…In the same report, 31 patients (7%) had late-onset hypotony (three of them with visual acuity decreased by >2 Snellen lines), and two patients developed bleb-related endophthalmitis (5) . Incidentally, another recent paper reported that visual loss after surgery, the "wipe-out" phenomenon, is rare, even in patients with advanced glaucomatous visual field loss and split fixation (6) . The Ex-Press ® implantation during glaucoma filtration surgery should be considered as a modification in trabeculectomy, and not as an entirely new procedure.…”

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confidence: 99%

Open-angle glaucoma surgery: the current standing

Tavares¹

2014

Arquivos Brasileiros De Oftalmologia

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Glaucoma is an optic neuropathy characterized by progressive degeneration of retinal ganglion cells (1) . It is the main cause of irreversible blindness in the world, and affects more than 70 million people worldwide, being 10% bilaterally blind (2) . Glaucoma can remain asymptomatic until it is severe, leading glaucoma filtration surgery to be performed in advanced cases, often by general ophthalmologists, which may be, in part, responsible for the wrong impression of its low success-rates and high incidence of complications. Therefore, glaucoma surgery is feared by patients and even by some ophthalmologists. Nevertheless, recently published studies on glaucoma surgery safety and efficacy have reported a different reality.First, due to recent diagnostic and therapeutic advancements, including improvements in surgery techniques, the 20-year probability of glaucoma-related blindness in at least one eye was reduced to half during the period from 1965 to 2009 (3) . One of these enhancements was the advent of the safe trabeculectomy technique, proposed by Peng Khaw from the Moorfields Eye Hospital (4) . Moreover, a multicenter analysis showed that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required. These authors showed an intraocular pressure (IOP) equal or less than 18 mmHg in 86% of the patients after a two-year follow-up period, when included hypotensive medication use (5) . They also reported antifibrotics use in 93% of the cases, what corroborated the current practice pattern among glaucoma specialists. The use of mitomycin-C (MMC) during trabeculectomy has not only enhanced its IOP-lowering effect, but also made the postoperative period more challenging. Suture manipulation (including massage, laser suture lysis, etc.), bleb needling and subconjunctival 5-fluorouracil injections are directly related to success, and demand both time and expertise. In the same report, 31 patients (7%) had late-onset hypotony (three of them with visual acuity decreased by >2 Snellen lines), and two patients developed bleb-related endophthalmitis (5) . Incidentally, another recent paper reported that visual loss after surgery, the "wipe-out" phenomenon, is rare, even in patients with advanced glaucomatous visual field loss and split fixation (6) . The Ex-Press ® implantation during glaucoma filtration surgery should be considered as a modification in trabeculectomy, and not as an entirely new procedure. A recent meta-analysis of randomized clinical trials comparing both procedures reported similar efficacy in IOP-lowering, medication reduction, vision recovery, qualified operative success-rates, and a greater incidence of most complications, with the exception of hyphema (7) . Controversy over its application in daily practice exists, as its efficacy and safety are similar to trabeculectomy, however it makes the procedure more costly.Non-penetrating surgical procedures, including deep sclerectomy (DS), are more difficult to perform and requi...

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“…However, the literature showed all three possible outcomes: an improvement in visual function, a decline, and no effect. (Balekudaru et al 2014, Caprioli et al 2016, Hagiwara et al 2000, Sehi et al 2010 The crucial question is, if there is a surgery-induced loss, if it counterbalances the loss avoided due to the IOP lowering. The IOP lowering aims to yield a lower rate of progression (ROP), that is, a less negative time rate of change of the standard automated perimetry (SAP) mean deviation (MD) -thus delaying blindness.…”

Section: Introductionmentioning

confidence: 99%

Dealing with perimetric variability in clinical glaucoma care

Montolio¹

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Prospective Evaluation of Early Visual Loss Following Glaucoma-filtering Surgery in Eyes With Split Fixation

Abstract: Visual loss after surgery in advanced glaucoma is rare and most often because of reversible causes.

Cited by 14 publications

References 8 publications

Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

Open-angle glaucoma surgery: the current standing

Dealing with perimetric variability in clinical glaucoma care

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