Clinical Validation of Visual Field Index in Glaucoma Patients with Central Visual Field Defects

PURPOSE: To evaluate the glaucoma discrimination ability of visual field index (VFI), a new perimetric index of Humphrey field analyzer II, in glaucoma patients with central and peripheral visual field defects (VFD). METHODS: Humphrey visual field test and OCT were performed in 204 glaucomatous eyes and 70 healthy eyes. The associations of VFI with mean deviation (MD), pattern standard deviation (PSD), and average retinal nerve fiber layer thickness (RNFLT) were analyzed using Pearson's correlation. The diagnostic abilities of the parameters were analyzed using the areas under the receiver operating characteristic curves (AUROC). The AUROC were compared between MD-matched patients with central VFD (at least one point with p 0.05). The AUROC value of VFI was greater than those of the MD and average RNFLT but was not different from that of PSD (p = 0.332) in the central VFD group. However, there were no significant differences between AUROC value of VFI and those of other parameters in the peripheral VFD group (all, p > 0.05). CONCLUSIONS: The results from the present study suggest that VFI may be more useful than MD in diagnosing glaucoma, especially in patients with central VFD.

Trabeculectomy for Medically Uncontrolled Acute Primary Angle-Closure Glaucoma

PURPOSE: To evaluate the outcomes of trabeculectomy performed on eyes with medically uncontrolled acute angle closure glaucoma (AACG). METHODS: The authors reviewed 31 eyes of 30 acute primary angle-closure glaucoma patients who had undergone trabeculectomy. The eyes were divided into two groups: eyes which did not respond to medical and/or laser treatment (Group A, 16 eyes) and those which initially responded to medical and/or laser treatment and later had an intraocular pressure (IOP) increase (Group B, 15 eyes). Complete success was defined as a final IOP below 21 mmHg without medication, and qualified success was defined as a final IOP below 21 mmHg with medication. Patients whose postoperative IOP was 22 mmHg or greater on at least two serial measurements or who required additional glaucoma surgery were classified as failures. RESULTS: The mean follow-up was 43.1+/-32.3 months. The five-year qualified success rate was 56.3% in Group A and 100% in Group B (log-rank test, p=0.02). The preoperative IOP was significantly higher in Group A (38.0+/-11.5 mmHg) than in Group B (21.8+/-12.2 mmHg) (p0.05). CONCLUSIONS: The medically uncontrolled AACG appears to have an adverse effect on the outcome of trabeculectomy. Success of trabeculectomy in AACG seems to be inversely related with elevated preoperative intraocular pressure.

Trabeculectomy for Medically Uncontrolled Acute Primary Angle-Closure Glaucoma

PURPOSE: To evaluate the outcomes of trabeculectomy performed on eyes with medically uncontrolled acute angle closure glaucoma (AACG). METHODS: The authors reviewed 31 eyes of 30 acute primary angle-closure glaucoma patients who had undergone trabeculectomy. The eyes were divided into two groups: eyes which did not respond to medical and/or laser treatment (Group A, 16 eyes) and those which initially responded to medical and/or laser treatment and later had an intraocular pressure (IOP) increase (Group B, 15 eyes). Complete success was defined as a final IOP below 21 mmHg without medication, and qualified success was defined as a final IOP below 21 mmHg with medication. Patients whose postoperative IOP was 22 mmHg or greater on at least two serial measurements or who required additional glaucoma surgery were classified as failures. RESULTS: The mean follow-up was 43.1+/-32.3 months. The five-year qualified success rate was 56.3% in Group A and 100% in Group B (log-rank test, p=0.02). The preoperative IOP was significantly higher in Group A (38.0+/-11.5 mmHg) than in Group B (21.8+/-12.2 mmHg) (p0.05). CONCLUSIONS: The medically uncontrolled AACG appears to have an adverse effect on the outcome of trabeculectomy. Success of trabeculectomy in AACG seems to be inversely related with elevated preoperative intraocular pressure.

The Usefulness of the Uniocular Drug Trial in the Glaucoma Eyes

PURPOSE: This study was undertaken to evaluate if the reduction of intraocular pressure (IOP) observed in a uniocular trial correlates with an IOP reduction observed in the fellow eye. METHODS: The study was performed on forty patients with bilateral glaucoma or suspect glaucoma who underwent a uniocular trial of 0.005% latanoprost and subsequently received the same drug in the fellow eye after 1 week. Inter-eye IOP variations were less than 3 mm Hg over two measurements, and were followed minimally for 4 weeks. The uniocular IOP reduction (IOP before medication - IOP after medication) and the net IOP reduction (IOP change in the trial eye after medication - IOP change in the fellow eye) were calculated. The uniocular IOP reduction and net IOP reduction in the trial eye was compared with the results from the fellow eye. RESULTS: The mean uniocular IOP reduction in the trial eye and the fellow eye were 3.6+/-2.42 mm Hg and 2.78+/-2.16 mm Hg, respectively (r=0.390, r2=0.152, P=0.013). The mean net IOP reduction in the trial eye and the opposing eye were 3.55+/-1.70 mm Hg and 3.15+/-1.83 mm Hg, respectively (r=0.782, r2=0.612, P=0.000). CONCLUSIONS: A uniocular drug trial in patients with similar IOPs between their eyes can adequately predict the IOP lowering effect of a medication.