Stability of the Central Visual Field After Modern Trabeculectomy Techniques in Eyes with Advanced Glaucoma

Abstract

To review the surgical results and complications of trabeculectomy techniques in patients with advanced glaucoma and threatened fixation. Trabeculectomy had been carried out on 49 advanced glaucoma patients (49 eyes) using mitomycin C and postoperative laser suture lysis. The clinical records prior to and 2 months after surgery were reviewed, and the long-term surgical outcomes were determined. Two months after surgery there were no eyes with fixation loss. Intraocular pressure (IOP) levels were reduced from 22.8 +/- 6.0 to 11.7 +/- 4.7 mmHg. Kaplan-Meier survival analysis showed that the success rate in achieving IOPs of 15 mmHg or lower 5 years after surgery was 70%. The chance of visual acuity remaining within two lines of the preoperative level was 75%. In 29 of the 49 eyes, visual acuities remained at their preoperative level at the time of the final visit, but had decreased to less than 0.1 in three eyes (cataract progression, n = 2; fixation loss, n = 1). The results suggest that laser suture lysis and stepwise management of IOP levels, which are performed as part of the modern postoperative management of trabeculectomy, decrease the frequency of fixation loss during the early postsurgical phase.