[The long-term outcome of trabeculectomy in advanced glaucoma].

PURPOSE: We evaluated retrospectively the surgical outcome of trabeculectomy in patients with advanced glaucoma.

METHODS

We studied 18 eyes of 18 patients with advanced glaucoma (mean age: 71.2 years, mean follow-up period: 41.1 months). In each eye, the visual field was at stage 5 of Aulhorn-Greve's classification before surgery.

RESULTS

Two eyes showed extreme hypotony (< 2 mmHg) 3 days after surgery and lost the central visual field permanently. Another 2 of 4 eyes which could not be maintained below 15 mmHg showed a worsening of visual field disturbance within stage 5 of Aulhorn-Greve's classification. The final visual acuity was 0.7 or better in 9 eyes (50.0%), 0.1 or worse in 2 eyes (11.1%). The final intraocular pressure (IOP) was below 10 mmHg without and with medication in 8 eyes (44.4%) and 2 eyes (11.1%) respectively. The final IOP was below 15 mmHg without and with medication in 11 eyes (61.1%) and 3 eyes (16.7%) respectively. Postoperative complications were observed in 4 eyes (22.2%).

CONCLUSIONS

The cause of postoperative central visual field worsening was associated with extreme intraocular hypotony (2 mmHg) rather than IOP elevation due to bleb dysfunction. This surgery may be effective as 14 eyes (78%) were able to maintain visual acuity and the central visual field.