Loss of visual acuity after trabeculectomy.
BACKGROUND
Glaucoma filtration surgery can result in loss of visual acuity by a variety of mechanisms. The existence of "wipe-out" (loss of the central visual field in the absence of other explanation) as a cause of postoperative loss of visual acuity has been debated. This study defines the incidence and etiology of visual acuity loss within 3 months of trabeculectomy.


METHODS
The authors reviewed 508 eyes of 440 patients who underwent trabeculectomy to find cases of postoperative visual acuity loss (2 or more Snellen lines or a category change) and randomly selected a control group of 85 eyes to analyze the risk factors for each cause of visual acuity loss.


RESULTS
Forty-two eyes (8.3%) showed loss of visual acuity after 3 months, caused mainly by lens opacification (n = 16), hypotony maculopathy (n = 6), and "wipe-out" (n = 4). Older patients (P = 0.0108), those in whom the visual field preoperatively showed macular splitting (P = 0.0084) and those who had severe hypotony (intraocular pressure [IOP] < or = 2 mmHg) on the first postoperative day (P = 0.0246) were more likely to experience "wipe-out." Older age (P = 0.0495) and shallow anterior chamber (P = 0.0003) were correlated to the development of lens opacification. Hypotony maculopathy was associated with coronary artery disease (P = 0.0397) and systemic hypertension (P = 0.0118).


CONCLUSIONS
Lens opacification was the main cause of early visual acuity loss after trabeculectomy, followed by hypotony maculopathy. "Wipe-out," although rare, does exist, and older patients with advanced visual field defects are at increased risk.
William and Anna Glaucoma Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA 19107.
V P
VP
Costa
M
M
Smith
G L
GL
Spaeth
S
S
Gandham
B
B
Markovitz
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications / Q000209:etiology; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D015994:Incidence; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000150:complications / Q000209:etiology; D012164:Retinal Diseases / Q000150:complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000009:adverse effects*; D014786:Vision Disorders / Q000209:etiology*; D014792:Visual Acuity