title: Trabeculectomy Can Improve Long-Term Visual Function in Glaucoma.
abstract: OBJECTIVE
  To measure the magnitude and direction of visual field (VF) rates of change in glaucoma patients after intraocular pressure (IOP) reduction with trabeculectomy.
  
  
  METHODS
  Retrospective, comparative, longitudinal cohort study.
  
  
  METHODS
  Patients with open-angle glaucoma.
  
  
  METHODS
  Patients who underwent trabeculectomy (Trab) with mitomycin-C (74 eyes of 64 patients) with ≥4 reliable VF measurements before and after trabeculectomy and at least 4 years of follow-up before and after surgery were included. Decay or improvement exponential models were used to calculate pointwise rates of perimetric change before and after surgery. A separate comparison (Comp) group with unoperated glaucoma (71 eyes of 65 patients) with similar baseline damage, number of VF tests, and follow-up was used to address possible regression to the mean. Proportions of VF locations decaying or improving before and after surgery in the Trab group, and during the first and second halves of follow-up in the Comp group, were calculated. A multivariate analysis was used to explore variables associated with VF improvement.
  
  
  METHODS
  The rate of pointwise VF change before and after surgery in the Trab group and Comp group.
  
  
  RESULTS
  Patients in the Trab group were followed for 5.1±2.1 years (mean ± standard deviation) before and 5.4±2.3 years after surgery, with 8.9±4.7 VF tests before and 9.0±4.4 VF tests after surgery. The mean rate of change for all VF locations slowed from -2.5±9.3%/year before surgery to -0.10±13.1%/year after surgery (P < 0.001). In the Trab group, 70% of locations decayed and 30% improved preoperatively; postoperatively, 56% decayed and 44% improved. The differences between the Trab and Comp groups were significant (P < 0.0001, chi-square test). The magnitude of IOP reduction correlated with the excess number of VF locations that exhibited long-term improvement postoperatively (P = 0.009). In the Trab group, 57% of eyes had ≥10 improving VF locations postoperatively.
  
  
  CONCLUSIONS
  The results show that trabeculectomy slows the rate of perimetric decay and provide evidence of sustained, long-term improvement of visual function in glaucoma. These findings suggest the possibility of reversal of glaucomatous dysfunction of retinal ganglion cells and their central projections.
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California. Electronic address: caprioli@jsei.ucla.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Caprioli
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: John Mark
authors.initials: JM
authors.lastname: de Leon
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Parham
authors.initials: P
authors.lastname: Azarbod
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chen
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Esteban
authors.initials: E
authors.lastname: Morales
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Kouros
authors.initials: K
authors.lastname: Nouri-Mahdavi
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Anne
authors.initials: A
authors.lastname: Coleman
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics and Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Biostatistics and Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
authors.forename: Abdelmonem
authors.initials: A
authors.lastname: Afifi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult