The Difference of Reversal of Glaucomatous Cupping After Filtration Surgery Between Advanced Glaucoma and Less Advanced Glaucoma

ABSTRACT

We investigated whether there was any difference in the extent of cupping reversal after reduction of intraocular pressure(IOP) by trabeculectomy between advanced glaucoma(stage IV of Jonas classification; 6 eyes) and less advanced glaucoma(stage III or less; 5 eyes). Computer-aided morphometry was performed in 11 eyes of 10 adult patients with chronic open-angle glaucoma in whom reversal of glaucomatous cupping was apparent photographically. Mean preoperative IOP, postoperative IOP, and percent reduction of IOP respectively were 42.5+/-8.3mmHg, 12.5+/-3.8mmHg, and 69.1+/-13.2%(range, 40.6 to 81.0%) over a mean period of 22.7+/-14.6 months(range, 5 to 53 months). Mean cup area and cup to disc ratio decreased significantly(P<0.01, Wilcoxon signed rank test). The reversal of rim area/disc area ratio showed a marginally significant correlation with the percent reduction of IOP(Spearman`s correlation coefficient=0.57, P=0.07). The reversal of vertical cup to disc ratio was significaltly lower in eyes with advanced glaucoma than in eyes with less advenced glaucoma(P=0.03, Mann-Whitney U test). Although reversal of other disc parameters tended to be lower in eyes with advanced glaucoma, they were not statistically significant. In eyes with advanced glaucoma, reversal of rim area/disc area ratio was more pronounced in the nasal disc region than in the superior or inferior disc region. Our results suggest that the extent of cupping reversal after reduction of IOP may decrease in the advanced stage of glaucoma than in mild to moderate stages of glaucoma.