The effect of trabeculectomy and glaucoma drainage device implantation on postural intraocular pressure changes in glaucomatous eyes.

Abstract

To investigate the effect of trabeculectomy and glaucoma drainage device implantation on posture related intraocular pressure (IOP) changes in glaucomatous eyes. Eyes in this prospective study were divided into three groups: those that underwent Ahmed glaucoma valve implantation (Ahmed group), those that underwent trabeculectomy with mitomycin C (trabeculectomy group) and those treated medically (medication group). IOP was measured in the sitting position, and after 15min in the left lateral decubitus position using a Tonopen XL, and a Goldmann applanation tonometer (GAT). For GAT measurements in the left lateral decubitus position, we used a specialized system comprised of a motorized bed attached to a modified slit-lamp table. 111 eyes of 64 glaucoma patients were included in the analysis: 19 in the Ahmed group, 46 in the trabeculectomy group and 46 in the medication group. The difference in IOP between the sitting and supine positions was significant in the medication (2.23mmHg) and trabeculectomy (1.48mmHg) groups, but not in the Ahmed group (0.53mmHg). This significance was reached with the GAT, but not with the Tonopen. A rise of 5mmHg or more between the sitting and supine positions was documented in 5.2%, 4.3% and 15.2% of eyes in the Ahmed, trabeculectomy and medication groups, respectively. Intraclass correlation coefficient for IOP measurements in the supine position demonstrated good correlation between the two tonometers. Ahmed valve surgery significantly reduces postural IOP response as compared with medically treated controls. There was no significant difference between Ahmed valve and trabeculectomy in terms of their effect on the postural IOP change.