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Optical Coherence Tomography Assessment of Risk Factors for Visual Acuity Decline After Trabeculectomy in Patients With Advanced Open-Angle Glaucoma

Asaoka, Kei MD; Kunimatsu-Sanuki, Shiho MD, PhD; Kokubun, Taiki MD; Nakazawa, Toru MD, PhD

doi: 10.1097/IJG.0000000000001305
Original Studies
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Précis: Thinning of the macular retinal nerve fiber layer (mRNFL) and ganglion cell complex in the papillomacular bundle area contributed significantly to visual acuity (VA) decline in advanced glaucoma patients after trabeculectomy.

Purpose: To identify structural parameters that could predict VA decline after trabeculectomy in patients with advanced open-angle glaucoma.

Patients and Methods: Retrospective review of 74 eyes of 74 patients with advanced glaucoma (defined as mean deviation −12 dB or worse) and best-corrected VA (BCVA) of ≥40/200. All patients underwent trabeculectomy between 2013 and 2016. Measurements included intraocular pressure, BCVA, visual field parameters, and optical coherence tomography-derived parameters [(in both the overall macula and within the papillomacular bundle (PMB)], including mRNFL thickness (mRNFLT), ganglion cell layer/inner plexiform layer thickness, and ganglion cell complex thickness. Measurements were obtained before and after surgery, and follow-up was at least 6 months. We grouped the patients according to whether they underwent VA decline of >3 lines of BCVA after 6 months. We then compared the VA-decline group and the stable-VA group and performed a receiver operating characteristic analysis to determine optimal cut-off values for predicting VA decline.

Results: The VA-decline group comprised 7 eyes (9.5%) and had lower preoperative mean deviation (P=0.021) and thinner mRNFL, ganglion cell layer/inner plexiform layer, and ganglion cell complex in the PMB (P=0.003, 0.135, and 0.023, respectively) than the stable-VA group. The cut-off values for predicting VA decline were 9.5 μm for mRNFLT in the PMB.

Conclusions: This study found that thin mRNFLT in the PMB were risk factors for VA decline after trabeculectomy.

Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan

Presented as a poster at 2017 ARVO-Asia meeting, February 2017, Brisbane, Australia.

K.A.: designed the study and wrote the manuscript, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. S.K.-S.: designed the study, interpreted the data, and reviewed and edited the manuscript. T.K.: collected the data. T.N.: made critical revisions to the manuscript for intellectual content.

Supported by JSPS KAKENHI (Grant number 18K09437).

Disclosure: The authors declare no conflict of interest.

Reprints: Toru Nakazawa, MD, PhD, Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai-shi, Miyagi-ken 980-8574, Japan (e-mail: ntoru@oph.med.tohoku.ac.jp).

Received July 27, 2018

Accepted May 13, 2019

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