Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

• Published in: British journal of ophthalmology Vol. 104; no. 12; pp. 1690 - 1696
• Main Authors: Ang, Bryan C H, Seen, Sophia, Kumaran, Arjunan, De Leon, John Mark Sim, Seah, Steve Kah Leng, Foster, Paul J, Gazzard, Gus, Htoon, Hla M, Khaw, Peng Tee, Aung, Tin, Husain, Rahat
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2020
• Subjects: Adult; Age; Aged; Diabetes; Diabetic retinopathy; Disease Progression; Ethnicity; Female; Fluorouracil - pharmacology; Follow-Up Studies; Glaucoma; Glaucoma, Open-Angle - epidemiology; Glaucoma, Open-Angle - physiopathology; Glaucoma, Open-Angle - therapy; Humans; Hypertension; Immunosuppressive Agents - pharmacology; Incidence; Intraocular Pressure - physiology; Male; Middle Aged; Patients; Postoperative Period; Pregnancy; Prospective Studies; Retrospective Studies; Singapore - epidemiology; Software; Surgery; Surgical outcomes; Time Factors; Tonometry, Ocular; Trabeculectomy; Visual Fields - physiology; Singapore; intraocular pressure; glaucoma
• DOI: 10.1136/bjophthalmol-2019-314121
• ISSN: 0007-1161; 1468-2079

Background/AimsThis 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.MethodsThis 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).Results127 (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.ConclusionIn post-trabeculectomy Asian eyes with well-controlled IOP, higher long-term IOP fluctuation may be associated with greater VF progression.