Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2023, Vol. 37 ›› Issue (4): 139-148.doi: 10.6040/j.issn.1673-3770.0.2022.181

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Long-term progress of visual field defect for open-angle glaucoma patients with ab interno trabeculotomy with the trabectome

MENG Sukun1,2, ZHANG Chun1,2   

  1. 1. Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China2. Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
  • Published:2023-07-27

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Abstract: Objective To observe the long-term efficacy of ab interno trabeculotomy with the Trabectome and the progress of visual field defect for open-angle glaucoma patients. Methods In this retrospective cohort study, 62 primary open-angle glaucoma patients who underwent ab interno trabeculotomy with the Trabectome were included. The main outcome measure was visual field, and the secondary outcome measures included intraocular pressure, the amount of glaucoma medications, and surgical complications. The Wilcoxon test was used to compare the postoperative intraocular pressure and the number of glaucoma medications with baselines. The Enhanced Glaucoma Staging System(GSS 2)was used to evaluate the severity of preoperative visual field defects and to stage the preoperative visual field. The parameters of diffuse visual field defect(mean defect of Octopus visual field test and mean deviation of Humphrey visual field test)in all follow-ups were analyzed by linear regression with time. Whether the visual field defect progressed or not was judged according to the slope of regression equation. Moreover, the risk factors of visual field defect progression were further explored. Results The preoperative intraocular pressure of all 62 cases was(20.9±7.5)mmHg and the preoperative number of glaucoma medications before was(2.6±1.2)species. After operation, intraocular pressure decreased to(17.6±3.4)mmHg(P=0.018)and the number of glaucoma medications decreased to(2.3±1.1)species(P=0.317)at 5 years. Fourteen cases(22.6%)experienced progression of visual field defects. There were differences in the history of diabetes and preoperative visual field staging between the two groups. The proportion of progressive cases in cases with diabetes was 46.2% compared to 16.3% in cases without diabetes(P=0.022). The percentage of progression of visual field defect was 38.9% in cases with mild preoperative visual field staging(stages 0-3)and 15.9% in cases with severe preoperative visual field staging(stages 4-5)(P=0.049). Conclusion Ab interno trabeculotomy with the Trabectome had a definite long-term efficacy. Some patients still had visual field defects progression after operation. Visual functional impairment of glaucoma should be considered during postoperative follow-up. Patients with diabetes and mild preoperative visual field stage were more likely to have visual field defects progression. The follow-up frequency of these patients should be increased and their visual field should be frequently monitored.

Key words: Ab interno trabeculotomy, Open-angle glaucoma, Visual field, Minimally invasive glaucoma surgeries, Risk factor

CLC Number: 

  • R775
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