Abstract

DO.16.05

Filtration surgery in end-stage glaucoma

Gracner T., Gracner B., Pahor D.
Oddelek za očesne bolezni, Univerzitetni klinični center Maribor, Maribor, Slovenija

Objective: To evaluate the effect of filtration surgery on eyes of patients with end-stage glaucoma during the immediate postoperative period.
Methods: 21 eyes of 21 patients with end-stage glaucoma in which goniotrephining with scleral flap without intraoperative antimetabolites was done were included in this retrospective study. Patients had advanced glaucomatous visual field (VF) defects with score over 16 according to the Advanced Glaucoma Intervention Study grading system on automated perimetry, or an extensive ring-shaped or half-ring-shaped absolute defect in the paracentral VF area extending up to 30° with or without a central island on Goldmann perimetry. The VF test results within 6 months before and after surgery were used for comparison. The intraocular pressure (IOP), the number of antiglaucoma medications and the best corrected visual acuity (BCVA) before and 3 months after surgery were evaluated. The incidence of intraoperative and postoperative complications were also noted.
Results: Preoperatively the mean value of the mean deviation in 12 eyes on automated perimetry was -27.35 dB (SD 2.1) and postoperatively -27.47 dB (SD 1.8) at the end of follow-up (p=0.584). Preoperatively the mean VF island in 9 eyes on Goldmann perimetry was 19.4° (SD 9.5) and postoperatively 19.1° (SD 9.9) at the end of follow-up (p=0.347). The mean IOP before surgery was 27.1 mmHg (SD 6.6), decreasing 3 months after surgery to a mean of 11.6 mmHg (SD 3.4) (p<0.0001). The mean number of antiglaucoma medications before surgery was 3.0 (SD 0.4), decreasing 3 months after surgery to a mean of 0.2 (SD 0.7) (p<0.0001). The mean preoperative BCVA was 0.43 (SD 0.3) and the mean postoperative BCVA was 0.36 (SD 0.3) at the end of follow-up (p=0.082). There were no intraoperative complications. Transient hypotony with choroidal detachment occurred in ten eyes postoperatively and resolved in all eyes within 10 days.
Conclusions: In patients with end-stage glaucoma, followed for 3 months after filtration surgery without intraoperative antimetabolites, the IOP was reduced effectively and vision was perserved with no occurrences of »wipe-out« phenomenon.

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