ROY W.BECK MD, PhD
To evaluate the association of long-term intraocular pressure (IOP) fluctuation and visual field (VF) progression in patients with glaucoma and low IOP.
Four hundred eight eyes with IOPs below 18 mm Hg after a triple procedure (phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy) were included in this study. Measurements of IOP and VF were taken for at least 3 years after surgery. Based on the SD in postoperative IOPs, the sample was split into 2 groups (group 1: SD ≤2; group 2: SD >2). Change in VF at each test location was defined as a change in threshold sensitivity of 1 dB per year or higher, with P≤.01; pointwise linear regression analysis was applied.
Main Outcome Measures
Intraocular pressure and VF progression.
The groups showed no differences in IOPs through the follow-up period and in the VF defect score 3 months after surgery. After 13 years, more patients with progressive VF deterioration were detected in group 2 than in group 1.
Our results showed that larger long-term IOP fluctuation was associated with a progressive increase in the VF deterioration even though patients with glaucoma maintained their IOPs after the triple procedure.
Application to Clinical Practice
The SD of long-term IOP should be less than 2 in patients with glaucoma, even if their IOPs drop below 18 mm Hg.
clinicaltrials.gov Identifier: LOCATOR="http://clinicaltrials.gov/show/NCT00428740">NCT00428740
Hong S, Seong GJ, Hong YJ. Long-term Intraocular Pressure Fluctuation and Progressive Visual Field Deterioration in Patients With Glaucoma and Low Intraocular Pressures After a Triple Procedure. Arch Ophthalmol. 2007;125(8):1010-1013. doi:10.1001/archopht.125.8.1010