Visual Field Changes after Internal Limiting Membrane Peeling in Glaucoma Patients with Epiretinal Membrane

PURPOSE: To report visual field changes after internal limiting membrane (ILM) peeling for macular epiretinal membrane (ERM) according to the severity of glaucoma. METHODS: A retrospective review of 37 eyes from 37 patients who underwent ILM peeling to treat ERM. Standard automated perimetry (Humphrey visual field 24-2 program) was performed preoperatively and postoperatively. Based on the Advanced Glaucoma Intervention Study (AGIS) scoring system of preoperative visual field, patients were classified into the early glaucoma (AGIS ≤ 1) group or the advanced glaucoma (AGIS ≥ 2) group. Postoperative visual field sensitivity at each point was compared with the preoperative value. RESULTS: Out of 37 eyes, 15 eyes had early glaucoma and 22 had advanced glaucoma. Eyes from both groups had poor postoperative visual field parameters. For eyes with advanced glaucoma, the visual field index was significantly reduced and the visual field damage was larger and wider compared to those with early glaucoma. In both groups, visual field impairment was greater on the nasal side than on the temporal side, and visual acuity was not significantly different. Postoperatively, the macular ganglion cell-inner plexiform layer thickness was decreased, especially on the temporal side of advanced glaucoma. CONCLUSIONS: Visual field impairment was greater and wider in eyes with advanced glaucoma than in those with early glaucoma after ILM peeling in patients with ERM.

Simplifying “target” intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma

Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target” IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having – mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. “Target” IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a “Target” IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.

The Surgical outcomes of combined Phacoemulsification, Posterior Chamber Lens Implantation and Trabeculectomy in Glaucoma Patients

PURPOSE: To access the surgical outcomes of combined cataract surgery and trabeculectomy in glaucoma patients. METHODS: Twenty one patients (23 eyes) with preoperative visual acuity over 0.3 treated by combined surgery in severance hospital from 1997 to 1999 were included in this study. We examined preoperative and postoperative visual acuity, intraocular pressure, number of ocular hypotensive eyedrops, visual field test retrospectively. RESULTS: A total of 21 patients (23 eyes) were observed. Mean preoperative intraocular pressure (IOP) were 18.62+/-2.58 mmHg and that of postoperative 1-year follow-up period were decreased to 15.43+/-2.04 mmHg (p<0.05). One, 2 and 3 years after surgery, 2 eyes (8%), 3 eyes (13%), 5 eyes (20%) were aggravated by Advanced Glauma Intervention Study (AGIS) scoring system, respectively. Although there was significant decrease in postoperative intraocular pressure (p<0.05), no significant change was observed in postoperative IOP, mean deviation (MD), and corrected pattern standard deviation (CPSD) between aggravated group and non aggravated group. CONCLUSIONS: The IOP was maintained under 21 mmHg following combined cataract surgery and trabeculectomy and AGIS score of some patients was aggravated during the follow up period. There were no significant difference in postoperative IOP, MD and CPSD between aggravated and non aggravated group, but rim volume and rim area decreased significantly in aggravated group at postoperative two years.