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Clinical science
Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study
  1. Bryan C H Ang1,2,
  2. Sophia Seen3,
  3. Arjunan Kumaran2,
  4. John Mark Sim De Leon2,4,
  5. Steve Kah Leng Seah2,
  6. Paul J Foster5,
  7. Gus Gazzard6,
  8. Hla M Htoon7,
  9. Peng Tee Khaw6,
  10. Tin Aung2,7,
  11. Rahat Husain2,7
  1. 1 National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
  2. 2 Singapore National Eye Centre, Singapore
  3. 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4 East Avenue Medical Center, Quezon City, Philippines
  5. 5 Division of Epidemiology, Institute of Ophthalmology, London, UK
  6. 6 Glaucoma, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
  7. 7 Singapore Eye Research Institute, Singapore
  1. Correspondence to Dr Bryan C H Ang, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore; Drbryanang{at}gmail.com

Abstract

Background/Aims This work aimed to study the effect of long-term intraocular pressure (IOP) fluctuation on visual field (VF) progression 8 years post-trabeculectomy in Asian eyes.

Methods This was a retrospective analysis of 8-year post-trabeculectomy data from The Singapore 5-Fluorouracil (5-FU) Study. VFs were analysed using Progressor software (Medisoft, Leeds, UK). Outcome measures included mean slope for VF per year, number of progressing points and mean slope for progressing points per year. Multivariate regression analyses were performed adjusting for age, gender, ethnicity, glaucoma type, intraoperative 5-FU, diabetes mellitus, hypertension, best pre-trabeculectomy VF mean deviation, post-trabeculectomy mean IOP, IOP reduction and IOP fluctuation (SD of IOPs at 6-monthly timepoints).

Results 127 (52.3%) subjects completed 8-year follow-up with ≥5 reliable VFs and ≥8 6-monthly IOP measurements. Mean age was 61.8±9.6 years. Post-operatively, mean IOP was 14.2±2.8 mm Hg and mean IOP fluctuation was 2.53±1.20 mm Hg. Higher IOP fluctuation was associated with greater mean slope for field (B=−0.071; p=0.013), number of progressing points (B=0.963; p=0.014) and VF progression as defined by ≥1 progressing point (OR=1.585; p=0.029). There was also a trend towards eyes with higher IOP fluctuation having ≥3 adjacent progressing points in the same hemifield (OR=1.489; p=0.055). Greater mean IOP reduction post-trabeculectomy was associated only with a lower mean slope for progressing points per year (B=−0.026; p=0.028). There was no significant effect of intra-operative 5-FU compared with placebo for all outcome measures.

Conclusion In post-trabeculectomy Asian eyes with well-controlled IOP, higher long-term IOP fluctuation may be associated with greater VF progression.

  • glaucoma
  • intraocular pressure

https://doi.org/10.1136/bjophthalmol-2019-314121

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    Footnotes

    • Twitter @Jmarkmd1, @gusgazzard

    • SS and AK contributed equally.

    • Contributors BA designed the study, performed the analyses and drafted and revised the paper. SS drafted and revised the paper. AK performed the analyses and drafted and revised the paper. JM monitored data collection. SKLS designed the data collection tools and monitored data collection. PJF designed the data collection tools and monitored data collection. GG designed the data collection tools and monitored data collection. HMH wrote the statistical plan and performed the analyses. PTK designed the data collection tools and monitored data collection. TA designed the data collection tools, monitored data collection and drafted and revised the paper. RH designed the data collection tools, monitored data collection and drafted and revised the paper. The following are members of the study team: Bryan C H Ang, Sophia Seen, Arjunan Kumaran, John Mark Sim De Leon, Steve Seah Kah Leng, Paul Foster, Gus Gazzard, Htoon Hla Myint, Khaw Peng Tee, Aung Tin and Rahat Husain.

    • 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.

    • Patient consent for publication Not required.

    • Ethics approval The study had the approval of the Ethical Review Committee of the Singapore National Eye Centre and was carried out in accordance with the tenets of the Declaration of Helsinki.

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

    • Data availability statement No data are available.

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