Risk of visual loss in advanced glaucoma after trabeculectomy and combined cataract surgery
Raquel M. Joaquin-Quino, MD , Patricia M. Khu, MD, MSc , Nilo Vincent Dg. Florcruz, M.D. , Jesus N. Sarol, PhD
Objective
This study determined the risk of postoperative visual loss and the factors affecting the decrease in visual acuity in patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery.
Methods
Charts of patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery were reviewed for the following parameters: visual acuity (VA), intraocular pressure (IOP), and visual-field indices of the Humphrey perimetry. Eyes that lost 2 or more Snellen lines or worsened one category two months after surgery were identified. Central vision was lost (wipeout) when best corrected VA was less than 20/200, characterized as a sudden, permanent, and unexplained visual loss within 2 months postoperatively. Analysis of variance (ANOVA) determined the differences between groups and logistic regression analyzed the factors affecting the decrease in visual acuity postoperatively.
Results
Ninety-eight eyes of 92 patients aged 18 years and older were included in the study. The incidence of postoperative visual loss 2 months after surgery was 20% (20/98), of which 3% (3/98) was considered “wipeout.” Factors affecting the decrease in VA postoperatively include the presence of surgical complications (p = 0.04) and increase in postoperative IOP at two months (p = 0.05).
Conclusion
The incidence of wipeout among patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery is low and generally occurs in patients with central-splitting fixation. Surgical complications play a major role in causing postoperative decrease in VA.
Keywords: Wipeout, Snuffout, Advanced glaucoma, Postoperative visual loss