Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure &lt; 15 mmHg

Naito, Takeo; Fujiwara, Masaru; Miki, Takako; Araki, Ryoichi; Fujiwara, Atsushi; Shiode, Yusuke; Morizane, Yuki; Nagayama, Mikio; Shiraga, Fumio

doi:10.1371/journal.pone.0184096

Cited by 29 publications

(37 citation statements)

References 30 publications

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“…during the following 9 months. When comparing the VF changes over one year in the present study with those obtained in other trials 1,[18][19][20][21][22] , the more advanced glaucomatous damage in our population needs to be considered. An important finding is that RNFL thickness significantly declined over the one-year study period.…”

Section: Discussionmentioning

confidence: 89%

One year structural and functional glaucoma progression after trabeculectomy

Chua

Kadziauskiene

Wong

et al. 2020

Sci Rep

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We evaluated the changes in visual field mean deviation (VF MD) and retinal nerve fibre layer (RNFL) thickness in glaucoma patients undergoing trabeculectomy. one hundred patients were examined with VF and spectral-domain optical coherence tomography (OCT) before trabeculectomy and 4 follow-up visits over one year. Linear mixed models were used to investigate factors associated with VF and RNFL. VF improved during the first 3 months of follow-up (2.55 ± 1.06 dB/year) and worsened at later visits (−1.14 ± 0.29 dB/year). RNFL thickness reduced by −4.21 ± 0.25 µm/year from 1st month of follow-up. Eyes with an absence of initial VF improvement (β = 0.64; 0.30-0.98), RNFL thinning (β = 0.15; 0.08-0.23), increasing intraocular pressure (IOP; β = −0.11; −0.18 to −0.03) and severe glaucoma (β = −10.82; −13.61 to −8.02) were associated with VF deterioration. Eyes with VF deterioration (β = 0.19; 0.08-0.29), increasing IOP (β = −0.09; −0.17 to −0.01), and moderate (β = −6.33; −12.17 to −0.49) or severe glaucoma (β = −19.58; −24.63 to −14.52) were associated with RNFL thinning. Changes in RNFL structure and function occur over a 1-year follow-up period after trabeculectomy.Early VF improvement is more likely to occur in patients with mild/moderate glaucoma, whereas those with severe glaucoma show greater decline over one year. Our findings indicate that progression is observable using OCT, even in late-stage glaucoma.Clinically, reduction of intraocular pressure (IOP) remains the only proven treatment for glaucoma 1-3 . Landmark glaucoma randomized clinical trials have confirmed the value of lowering IOP in delaying visual field (VF) progression 1-5 . Interestingly, recent studies 6-8 have reported that the surgical lowering of IOP in glaucoma can result in the improvement of VF, which lends support to the preliminary data reported by Katz and Spaeth, who demonstrated reversal of structural change and field loss in newly diagnosed patients after commencement of treatment 9,10 .Apart from functional changes, others have examined structural changes after trabeculectomy and their potential association with functional changes. The association between structural glaucomatous damage with VF decline after trabeculectomy is complex. The MoreFlow Medical Research Council 5-Fluorouracil (5-FU) study reported that out of 250 eyes, 20 eyes showed structural progression, 35 eyes showed VF progression, and 15 eyes showed both over a five years period 11 . In the Collaborative Initial Glaucoma Treatment Study (CIGTS), VF worsening was significantly associated with enlargement of the optic cup, but reversal of cupping was not associated with improvement of the VF 12 . Other studies reported an early increase in retinal nerve fiber layer (RNFL) thickness after trabeculectomy, but did not investigate the relation with VF changes [13][14][15][16][17] . Also, these studies have used the older time-domain optical coherence tomography (OCT) 14,16 , stereoscopic optic disc photographs 12,15 scanning laser polarimetry 17 , or Heidelberg Retina Tom...

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Section: Discussionmentioning

confidence: 89%

One year structural and functional glaucoma progression after trabeculectomy

Chua

Kadziauskiene

Wong

et al. 2020

Sci Rep

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“…2 Surgical management of NTG patients is especially challenging, since very low IOPs are required to achieve therapeutic reduction from baseline levels within the normal range. 5 Consequently, surgeons face a narrow therapeutic window between these low target pressures and potentially dangerous hypotonus pressures. 6 …”

Section: Introductionmentioning

confidence: 99%

“…Trabeculectomy has traditionally been the first-line surgical option for NTG patients, since it is capable of meeting low IOP goals in NTG patients, 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 even when single-digit postsurgical IOPs are required. 13 However, as a relatively invasive procedure, trabeculectomy has historically suffered from high complication rates, including long-term hypotony especially in NTG patients, ranging from 28 to 30%, 6 , 12 which can lead to cataract formation, 14 hypotonous maculopathy, 6 , 13 and choroidal detachment.…”

Section: Introductionmentioning

confidence: 99%

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris

Valle

2020

American Journal of Ophthalmology Case Reports

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Purpose To provide the first report of effective use of bilateral XEN Gel Stent implantation using an ab externo open-conjunctival approach designed to improve bleb function and meet the uniquely low intraocular pressure requirements of a Japanese patient with normal-tension glaucoma refractory to topical medical therapy. Observations A 54-year-old phakic Japanese woman with severe normal-tension glaucoma on maximally tolerated medical therapy of four topical agents presented with above-goal intraocular pressures and new medication intolerances. She underwent bilateral ab externo open-conjunctival XEN Gel Stent implantation with tenectomy and sub-Tenon's injection of 40μg of mitomycin-C, which resulted in reduction of intraocular pressures by 41.2 and 28.6% to 10 and 10 mmHg in the right and left eyes, respectively at the most recent visit. Postoperatively, a diffuse filtering bleb with good morphology developed in both eyes. The procedure has so far allowed for complete cessation of all four topical medications for up to eight months following surgery without any serious complications. Conclusions This case illustrates the potential of Xen Gel Stent implantation through an ab externo, open-conjunctival approach to be an effective, simple alternative to trabeculectomy to meet the unique low-pressure requirements of normal-tension glaucoma patients with practical and safety benefits of a micro-invasive approach.

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“…Many patients may continue to experience disease progression, although they have IOP within the normal range (Shiose et al 1991;Anderson et al 2003). Many studies (Aoyama et al 2010;Jayaram et al 2016;Schultz et al 2016;Naito et al 2017;Oie et al 2017) have shown that trabeculectomy can significantly reduce IOP and prevent progression of visual field disorders. We presume that maintenance of visual function can be expected when trabeculectomy is performed in glaucoma patients with IOP maintained in the normal range by topical medications.…”

Section: Total Case (%)mentioning

confidence: 99%

Effectiveness of trabeculectomy with mitomycin C for glaucomatous eyes with low intraocular pressure on treatment eye drops

Yuasa

Sugimoto

Hirooka

et al. 2019

Acta Ophthalmologica

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Purpose: To examine the efficacy and safety of current trabeculectomy with mitomycin C in Japan for glaucomatous eyes with low intraocular pressure (IOP). Methods: Two hundred ninety-four eyes of 294 patients with IOP ≤21 mmHg before surgery were studied; all patients were participants in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS), a multicentre, prospective, cohort study conducted at 34 ophthalmological institutions throughout Japan. All eyes had an intraocular pressure ≤ 21 mmHg and had undergone trabeculectomy alone or phacotrabeculectomy. Two success criteria were used: Criterion A comprised 20% reduction of baseline IOP and Criterion B comprised 30% reduction of baseline IOP. The primary outcome was the success rate for each of these criteria. Results: The qualified success rates were 87.3% for Criterion A and 42.0% for Criterion B at 5 years. Mean IOP was significantly reduced, from 16.7 AE 2.7 to 11.6 AE 4.0 mmHg at 5 years after trabeculectomy (p < 0.0001); the number of anti-glaucoma medications significantly decreased from 2.7 AE 1.1 to 1.0 AE 1.2 (p < 0.0001) at 5 years after the surgery. Three or more trabeculectomies, and needling were related to increased risk of failure. Incidences of postoperative hyphema, infection, shallow anterior chamber and bleb leakage were 2.4%, 2.4%, 2.0% and 3.4%, respectively. Conclusions: This study showed that trabeculectomy with mitomycin C is an effective procedure with few surgical complications for reducing IOP in patients, even if preoperative IOP was within the normal range.

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Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure < 15 mmHg

Cited by 29 publications

References 30 publications

One year structural and functional glaucoma progression after trabeculectomy

One year structural and functional glaucoma progression after trabeculectomy

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Effectiveness of trabeculectomy with mitomycin C for glaucomatous eyes with low intraocular pressure on treatment eye drops

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