Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy.
OBJECTIVE
To evaluate the visual outcomes in patients with advanced visual field (VF) loss undergoing trabeculectomy with mitomycin C.


METHODS
The records of patients with severe preoperative VF defects undergoing trabeculectomy from June 1, 1998, through October 31, 2005, were retrospectively reviewed. Severe loss of central vision was defined as visual acuity (VA) of 20/200 or less in the affected eye, counting fingers or less if preoperative VA was less than 20/200, or more than a 4-line reduction in Snellen VA.


RESULTS
Central vision loss occurred in 7 of 117 patients (eyes) (6%) because of hypotony maculopathy (3 cases), uncontrolled elevated intraocular pressures (2 cases), posterior subcapsular cataract increase (1 case), and inflammatory reaction (1 case). A statistically significant mean VA reduction after surgery from -0.32 to -0.39 (logMAR, P=.01) was found. Differences in VF parameters before and after surgery were not statistically significant. Patients who had severe loss of central vision had statistically significantly higher mean+/-SD preoperative intraocular pressures (27.1+/-8.8 mm Hg vs 19.7+/-8.1 mm Hg; P=.04) and higher rates of surgical complications (43% vs 4%; P=.001) compared with those who did not.


CONCLUSIONS
Severe loss of central vision after a trabeculectomy with mitomycin C occurred in 6% of patients who had glaucoma with marked VF loss. These patients had higher preoperative intraocular pressures and higher rates of surgical complications. Unexplained severe loss of central vision (snuff-out) was rare.
Law
Simon K
SK
Jules Stein Eye Institute, Los Angeles, CA 90095, USA. law@jsei.ucla.edu
Nguyen
Anne M
AM
Coleman
Anne L
AL
Caprioli
Joseph
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D011183:Postoperative Complications; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests; D014794:Visual Fields
D000477:Alkylating Agents; D016685:Mitomycin