The long-term outcome of glaucoma filtration surgery

PURPOSE: To determine the long-term outcome of glaucoma filtration surgery in preserving vision. Visual loss from progressive glaucomatous damage and from complications of surgery, both short and long term, were included. METHODS: A retrospective, community-based, longitudinal study of residents of...

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Veröffentlicht in:American journal of ophthalmology 2001-07, Vol.132 (1), p.27-35
Hauptverfasser: Parc, Christine E, Johnson, Douglas H, Oliver, Jessica E, Hattenhauer, Matthew G, Hodge, David O
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container_end_page 35
container_issue 1
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container_title American journal of ophthalmology
container_volume 132
creator Parc, Christine E
Johnson, Douglas H
Oliver, Jessica E
Hattenhauer, Matthew G
Hodge, David O
description PURPOSE: To determine the long-term outcome of glaucoma filtration surgery in preserving vision. Visual loss from progressive glaucomatous damage and from complications of surgery, both short and long term, were included. METHODS: A retrospective, community-based, longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with open-angle glaucoma between 1965 and 1980 and underwent filtration surgery in these or subsequent years through 1998. Intraocular pressure (IOP), visual acuity, visual fields, and progression to legal blindness were monitored. Kaplan-Meier analysis was used to determine the cumulative probabilities of changes in these parameters. RESULTS: 73 eyes of 49 patients underwent conventional filtration surgery. Analysis of the first eye having surgery revealed a mean preoperative IOP of 27.6 ± 8.5 mm dropping to 16.7 ± 5.6 mm at year one, and remaining in this range throughout follow-up (14.7 ± 3.0 mm at 10 years; with or without use of medications). The probability of progression to blindness was 46% at 10 years after surgery, as calculated by Kaplan-Meier analysis. Eyes going blind had a postoperative IOP equal to or lower than those not becoming blind (14.0 ± 4.4 vs. 15.4 ± 3.0 at postoperative year 10). Eyes going blind had more advanced field loss at the time of surgery, with scotomas above and below the horizontal axis, than eyes not going blind, which had scotomas in only one hemifield. Three patients developed late bleb leaks; two patients developed endophthalmitis. The probability of undergoing cataract surgery was 37% by 10 years postoperatively, which did not differ significantly from the cohort of patients not undergoing surgery at a comparable time point. CONCLUSIONS: Filtration surgery was associated with a 54% probability of preservation of vision from progression to legal blindness at 10 years after surgery. Patients becoming blind had more advanced field loss at the time of surgery; IOP was similar between those going blind and those retaining vision.
doi_str_mv 10.1016/S0002-9394(01)00923-0
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Visual loss from progressive glaucomatous damage and from complications of surgery, both short and long term, were included. METHODS: A retrospective, community-based, longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with open-angle glaucoma between 1965 and 1980 and underwent filtration surgery in these or subsequent years through 1998. Intraocular pressure (IOP), visual acuity, visual fields, and progression to legal blindness were monitored. Kaplan-Meier analysis was used to determine the cumulative probabilities of changes in these parameters. RESULTS: 73 eyes of 49 patients underwent conventional filtration surgery. Analysis of the first eye having surgery revealed a mean preoperative IOP of 27.6 ± 8.5 mm dropping to 16.7 ± 5.6 mm at year one, and remaining in this range throughout follow-up (14.7 ± 3.0 mm at 10 years; with or without use of medications). The probability of progression to blindness was 46% at 10 years after surgery, as calculated by Kaplan-Meier analysis. Eyes going blind had a postoperative IOP equal to or lower than those not becoming blind (14.0 ± 4.4 vs. 15.4 ± 3.0 at postoperative year 10). Eyes going blind had more advanced field loss at the time of surgery, with scotomas above and below the horizontal axis, than eyes not going blind, which had scotomas in only one hemifield. Three patients developed late bleb leaks; two patients developed endophthalmitis. The probability of undergoing cataract surgery was 37% by 10 years postoperatively, which did not differ significantly from the cohort of patients not undergoing surgery at a comparable time point. CONCLUSIONS: Filtration surgery was associated with a 54% probability of preservation of vision from progression to legal blindness at 10 years after surgery. Patients becoming blind had more advanced field loss at the time of surgery; IOP was similar between those going blind and those retaining vision.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/S0002-9394(01)00923-0</identifier><identifier>PMID: 11438050</identifier><identifier>CODEN: AJOPAA</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Blindness - prevention &amp; control ; Cataract Extraction ; Disease Progression ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle - physiopathology ; Glaucoma, Open-Angle - surgery ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular ; Male ; Medical sciences ; Postoperative Complications ; Probability ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. 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Visual loss from progressive glaucomatous damage and from complications of surgery, both short and long term, were included. METHODS: A retrospective, community-based, longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with open-angle glaucoma between 1965 and 1980 and underwent filtration surgery in these or subsequent years through 1998. Intraocular pressure (IOP), visual acuity, visual fields, and progression to legal blindness were monitored. Kaplan-Meier analysis was used to determine the cumulative probabilities of changes in these parameters. RESULTS: 73 eyes of 49 patients underwent conventional filtration surgery. Analysis of the first eye having surgery revealed a mean preoperative IOP of 27.6 ± 8.5 mm dropping to 16.7 ± 5.6 mm at year one, and remaining in this range throughout follow-up (14.7 ± 3.0 mm at 10 years; with or without use of medications). The probability of progression to blindness was 46% at 10 years after surgery, as calculated by Kaplan-Meier analysis. Eyes going blind had a postoperative IOP equal to or lower than those not becoming blind (14.0 ± 4.4 vs. 15.4 ± 3.0 at postoperative year 10). Eyes going blind had more advanced field loss at the time of surgery, with scotomas above and below the horizontal axis, than eyes not going blind, which had scotomas in only one hemifield. Three patients developed late bleb leaks; two patients developed endophthalmitis. The probability of undergoing cataract surgery was 37% by 10 years postoperatively, which did not differ significantly from the cohort of patients not undergoing surgery at a comparable time point. CONCLUSIONS: Filtration surgery was associated with a 54% probability of preservation of vision from progression to legal blindness at 10 years after surgery. 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the eye and orbit</topic><topic>Survival Analysis</topic><topic>Trabeculectomy</topic><topic>Treatment Outcome</topic><topic>Visual Acuity</topic><topic>Visual Fields</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parc, Christine E</creatorcontrib><creatorcontrib>Johnson, Douglas H</creatorcontrib><creatorcontrib>Oliver, Jessica E</creatorcontrib><creatorcontrib>Hattenhauer, Matthew G</creatorcontrib><creatorcontrib>Hodge, David O</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parc, Christine E</au><au>Johnson, Douglas H</au><au>Oliver, Jessica E</au><au>Hattenhauer, Matthew G</au><au>Hodge, David O</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The long-term outcome of glaucoma filtration surgery</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2001-07-01</date><risdate>2001</risdate><volume>132</volume><issue>1</issue><spage>27</spage><epage>35</epage><pages>27-35</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><coden>AJOPAA</coden><abstract>PURPOSE: To determine the long-term outcome of glaucoma filtration surgery in preserving vision. Visual loss from progressive glaucomatous damage and from complications of surgery, both short and long term, were included. METHODS: A retrospective, community-based, longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with open-angle glaucoma between 1965 and 1980 and underwent filtration surgery in these or subsequent years through 1998. Intraocular pressure (IOP), visual acuity, visual fields, and progression to legal blindness were monitored. Kaplan-Meier analysis was used to determine the cumulative probabilities of changes in these parameters. RESULTS: 73 eyes of 49 patients underwent conventional filtration surgery. Analysis of the first eye having surgery revealed a mean preoperative IOP of 27.6 ± 8.5 mm dropping to 16.7 ± 5.6 mm at year one, and remaining in this range throughout follow-up (14.7 ± 3.0 mm at 10 years; with or without use of medications). The probability of progression to blindness was 46% at 10 years after surgery, as calculated by Kaplan-Meier analysis. Eyes going blind had a postoperative IOP equal to or lower than those not becoming blind (14.0 ± 4.4 vs. 15.4 ± 3.0 at postoperative year 10). Eyes going blind had more advanced field loss at the time of surgery, with scotomas above and below the horizontal axis, than eyes not going blind, which had scotomas in only one hemifield. Three patients developed late bleb leaks; two patients developed endophthalmitis. The probability of undergoing cataract surgery was 37% by 10 years postoperatively, which did not differ significantly from the cohort of patients not undergoing surgery at a comparable time point. CONCLUSIONS: Filtration surgery was associated with a 54% probability of preservation of vision from progression to legal blindness at 10 years after surgery. Patients becoming blind had more advanced field loss at the time of surgery; IOP was similar between those going blind and those retaining vision.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11438050</pmid><doi>10.1016/S0002-9394(01)00923-0</doi><tpages>9</tpages></addata></record>
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subjects Aged
Biological and medical sciences
Blindness - prevention & control
Cataract Extraction
Disease Progression
Female
Follow-Up Studies
Glaucoma, Open-Angle - physiopathology
Glaucoma, Open-Angle - surgery
Humans
Intraocular Pressure
Lens Implantation, Intraocular
Male
Medical sciences
Postoperative Complications
Probability
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the eye and orbit
Survival Analysis
Trabeculectomy
Treatment Outcome
Visual Acuity
Visual Fields
title The long-term outcome of glaucoma filtration surgery
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