Publications (2)3.55 Total impact
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Article: Visual recovery after trabeculectomy.
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ABSTRACT: We retrospectively analyzed 155 eyes of 155 patients who underwent trabeculectomy with and without antimetabolites to determine the time for recovery of visual acuity postoperatively and to determine factors associated with delayed recovery of visual acuity and visual loss.Methods: Factors examined included age, race, preoperative visual field grading. Humphrey Field Analyzer's indices (mean deviation and corrected pattern standard deviation), optic nerve cup-to-disk ratio, antimetabolite use, postoperative complications, and postoperative hypotony. The mean age of the patient was 63.6 +/- 15.7 years. Mean follow-up was 14.4 +/- 8.5 months (range 6-30). One hundred forty-four patients (93%) regained their preoperative visual acuity, and 11 patients (7%) sustained visual loss. For the 144 patients who regained visual acuity, recovery time ranged between 1 and 244 days (median 6); recovery occurred before the second month in 128 patients (89%) and was delayed beyond 2 months in 16 patients (11%). Among the 60 primary open-angle glaucoma patients with preoperative visual acuity better than 20/200, those with delayed visual recovery had significantly worse preoperative visual field grades than did those with early recovery (p = 0.04). The preoperative Humphrey mean deviation was also higher (16.3 dB vs. 11.2 dB, p = 0.04). All 16 patients with delayed visual recovery also had postoperative hypotony (p = 0.01); this was transient (<2 weeks) in 12 patients and prolonged in four. In patients who failed to regain visual acuity, the visual loss did not correlate with any preoperative risk factors or hypotony, but these patients did have a higher incidence of postoperative complications (p = 0.05). We conclude that patients with primary open-angle glaucoma who have advanced visual field defects are at greater risk of delayed visual recovery after trabeculectomy and that postoperative hypotony contributes to this delay.Journal of Glaucoma 08/1995; 4(4):228-34. · 1.78 Impact Factor -
Article: Hypotony following trabeculectomy.
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ABSTRACT: To determine the risk factors for development of postoperative hypotony and the effects of hypotony on the outcome of surgery in terms of intraocular pressure (IOP) control and final visual acuity in patients who underwent standard trabeculectomy, trabeculectomy with postoperative 5-fluorouracil injections, trabeculectomy with intraoperative mitomycin-C, or trabeculectomy with both antimetabolites. We retrospectively reviewed the outcome in 155 eyes of 155 patients who underwent standard trabeculectomy (n = 15), trabeculectomy with postoperative 5-fluorouracil injections (n = 81), trabeculectomy with intraoperative mitomycin-C (n = 55), or trabeculectomy with both antimetabolites (n = 4). Hypotony developed in 108 (69.6%) eyes (IOP < 6 mm Hg) at some point postoperatively; this was transient (< 14 days) in 75 eyes, and prolonged (> 14 days) in 33 eyes. The positive preoperative factors for the development of prolonged hypotony were young age, myopia, and preoperative use of carbonic anhydrase inhibitor. The mean age of patients in whom prolonged hypotony developed was 57.3 +/- 18.3 years (compare the mean age without prolonged hypotony, 65.3 +/- 14.5 years, p = 0.02). Sixteen of 33 (48%) patients in whom prolonged hypotony developed were myopic (p = 0.02), and 23 of 33 (70%) patients in whom prolonged hypotony developed used preoperative carbonic anhydrase inhibitor (p = 0.07). There was no difference in the incidence of hypotony between patients who received 5-fluorouracil and those who received mitomycin-C. Postoperative hypotony was associated with three types of postoperative complications: shallow anterior chamber, choroidal detachment, and hypotony maculopathy (p = 0.02, 0.000, and 0.05, respectively). Hypotony did not have any effect on the success of surgery in terms of IOP control, but did have an effect on the visual outcome. Fourteen of the 33 patients (42.4%) in whom prolonged hypotony developed had worse visual acuity (p = 0.002); of these cases, four were due to hypotony maculopathy.Journal of Glaucoma 04/1995; 4(2):73-9. · 1.78 Impact Factor
