The Research For Controlling Of Intraocular Pressure And Visual Field Progression After Trabeculectomy In Primary Open-angle Glaucoma

PURPOSE:To investigate the association between control of intraocular pressure and visual field progression after trabeculectomy in primary open-angle glaucoma in follow-up, for guiding individualized therapy.METHODS:To select 47 cases (60 eyes) after trabeculectomy in primary open-angle glaucoma. Subjects are divided into two groups: visual field progressive group and visual field steady group with the Advanced Glaucoma Intervention Study (AGIS) scoring method. Two groups are classified early stage, moderate stage and severe stage by visual fields before operation with the Modified Hodapp-Parrish-Anderson Visual Fields Grading System. To observe moderate and severe change of two groups between preoperation and postoperation in intraocular pressure, mean defect(MD),pattern standard deviation(PSD) and AGIS scoring and change intraocular pressure, mean defect(MD),pattern standard deviation(PSD),AGIS scoring and fluctuation of intraocular pressure in postoperation. After dividing groups by intraocular pressure less than or equal to 12mmHg and upper limit of normal intraocular pressure(more than 21mmHg), observing change of intraocular pressure in the corrsponding period to following-up years. Then, making a comparison between in two groups. Lastly, analyzing the relation and correlation between the intraocular pressure and absolute value of mean defect(MD),pattern standard deviation(PSD) and AGIS scoring in preoperation and postoperation ,and between the fluctuation of intraocular pressure and absolute value of mean defect(MD),pattern standard deviation(PSD) and AGIS scoring in postoperation.RESULTS: (1)Visual field steady group after trabeculectomy in early stage,intraocular pressure, absolute value of mean defect(MD) and AGIS scoring dramatically drop compared with preoperation and there is significant difference instatistics (P<0.01). Pattern standard deviation(PSD) raise compared with preoperation with obvious turn to for the better (P<0.05).Fluctuation of intraocular pressure is less and there is not significant difference in statistics (P>0.05) . Visual field progressive group after trabeculectomy in early stage,intraocular pressure dramatically drop compared with preoperation and there is significant difference in statistics (P<0.01). Absolute value of mean defect(MD) were lower than preoperation and there was not significant difference in statistics (P>0.05) . Pattern standard deviation(PSD) and AGIS scoring increase compared with preoperation with obvious turn to for the better (P<0.05).Fluctuation of intraocular pressure is great with obvious turn to for the better (P<0.05). As follow-up years prolonging,both two of intraocular pressure, absolute value of mean defect(MD),AGIS scoring and fluctuation of intraocular pressure ascended to and visual field progressive group is higher than visual field steady group in postoperation. But there is not significant difference in two groups in pattern standard deviation(PSD). (2)Intraocular pressure less than or equal to 12mmHg by 8 %-32% ,uncontrol upper limit of normal intraocular pressure below(more than 21mmHg) by 5%-9% and control from 13mmHg to 21mmHg by 64%-92%after trabeculectomy in visual field steady group. Average is 13.90±2.76-15.60±1.14 and stable in follow-up years. Intraocular pressure less than or equal to 12mmHg by 6% -18 % ,uncontrol upper limit of normal intraocular pressure below (more than 21mmHg) by 6% -18% and control from 13mmHg to 21mmHg by 76%-94% after trabeculectomy in visual field progressive group. Average is 15.88±2.52-19.00±0.00. Intraocular pressure less than or equal to 12mmHg by 6% ,uncontrol upper limit of normal intraocular pressure below (more than 21mmHg) by 12% and control from 13mmHg to 21mmHg by 82% when visual field progression. Controling range is from 12mmHg to 27mmHg. (3)Intraocular pressure is in directly correlated with mean defect(MD) before operation and there is significant difference in statistics (P<0.05). Intraocular pressure is not in directly correlated with pattern standard deviation(PSD) and AGIS scoring before operation and there is not significant difference in statistics (P>0.05) . Intraocular pressure and fluctuation of intraocular pressure is in directly correlated with mean defect(MD) and AGIS scoring after operation and there is significant difference in statistics (P<0.05). Intraocular pressure and fluctuation of intraocular pressure is not in directly correlated pattern standard deviation(PSD) after operation and there is not significant difference in statistics (P>0.05 ) .CONCLUSIONS: The primary open-angle glaucoma after trabeculectomy, early good effect, but with the extended follow-up period, the outlook is deteriorating trend. Most patients, the lower intraocular pressure control, day and night Intraocular pressure smaller fluctuations, progress will be slow visual field. A small number of patients unable to control intraocular pressure below the normal range upper line, but the outlook remained stable. A very small number of patients control intraocular pressure in the so-called goal of intraocular pressure, visual field still progress. Therefore, we must be based on follow-up visual field to formulate a individual goal of intraocular pressure. Cannot be treated as the same.