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Lifetime visual outcomes of patients undergoing trabeculectomy
  1. Ruth Chen,
  2. Anthony J King
  1. Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Anthony J King, Department of Ophthalmology, Nottingham University NHS Trust, Derby Rd, Nottingham, UK; anthony.king{at}nottingham.ac.uk

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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Footnotes

  • Contributors RC wrote the manuscript and conducted data collection, analysis and statistical analyses. AJK planned the study, critically revised, provided feedback and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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