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Lifetime visual outcomes of patients undergoing trabeculectomy

Abstract

Background The most important outcome for patients undergoing trabeculectomy is to maintain the quality of life in their remaining years. This study quantifies end of life vision in terms of visual acuity (VA) and visual field status.

Methods A prospective service evaluation of patients undergoing trabeculectomy (from 2000 to 2012) who died prior to the study evaluation point (November 2018). Demographic data including socioeconomic status were collected and change in clinical measurement for the cohort between time of surgery and death was measured.

Results 160 of 659 patients had died (24.3%), 4 were excluded due to insufficient data, leaving 156 patients (196 eyes) for evaluation. Male-to-female ratio was 3:2, 86% of patients were Caucasian. Mean age at surgery on first eye was 76.5 years (SD 9.0). Life expectancy post-trabeculectomy was 7.5 years (0.1–17.2). Mean change in VA was logarithm of the mean angle of resolution (LogMAR) 0.32 (SD 0.59) and visual field mean deviation progressed at a median of −0.44 dB/year (from −5.98 to 3.9) for eyes with at least a year of follow-up. Severe vision loss (loss of ≥10 letters on LogMAR) occurred in 78 eyes (40%) of which 18 (9%) were due to glaucoma, 69 patients (44%) required glaucoma drops at end of life.

Conclusion Trabeculectomy is successful in slowing or preventing further glaucoma progression and thus maintaining visual function in the majority of eyes for the remainder of life. For those with severe vision loss at the end of life, only one in four was due to further progression of their glaucoma.

  • Glaucoma
  • Intraocular pressure
  • Treatment Surgery

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