Influence of Trabeculectomy with Mitomycin C on Longitudinal Changes in the Visual Field in Glaucoma Patients with High Myopia

Abstract

Purpose

To evaluate the effect of trabeculectomy (Trab MMC) on visual field (VF) progression in eyes with glaucoma and high myopia.

Patients and Methods

Patients diagnosed with primary open-angle glaucoma or exfoliation glaucoma who underwent Trab MMC as the first glaucoma surgery along with ≥3 VF tests preoperatively and postoperatively were enrolled. High myopia was defined as an axial length ≥26.5 mm. Postoperative reductions in intraocular pressure (IOP) were assessed by survival analysis using IOP measurements obtained preoperatively. The longitudinal trends of the outcome measures were evaluated using linear mixed models.

Results

Thirty-five eyes of 32 patients were included in this study, including 22 eyes of 20 patients in non-highly myopic group and 13 eyes of 12 patients in highly myopic group. IOP decreased after Trab MMC, and the survival rate did not differ significantly in relation to axial length. Linear mixed-model analyses suggested that the inhibitory effects of Trab MMC on the rate of mean deviation (MD) changes were significant in the non-highly myopic group (−0.53 ± 0.15 dB/year preoperatively to −0.16 ± 0.13 dB/year postoperatively; P = 0.004), but not in the highly myopic group (−0.66 ± 0.19 dB/year preoperatively to −0.48 ± 0.18 dB/year postoperatively; P = 0.32).

Conclusion

Trab MMC reduced IOP in both highly myopic and non-highly myopic eyes, and IOP reduction was very similar in both groups. The VF deterioration rate decreased in both groups, but the change was weaker and nonsignificant in the highly myopic group.

Keywords:

• glaucoma
• myopia
• trabeculectomy
• glaucoma progression

Abbreviations

BCVA, best-corrected visual acuity; CI, confidential interval; GEE, generalized estimating equation; HFA, Humphrey Visual Field Analyzer; IOL, intraocular lens; IOP, intraocular pressure; LMM, linear mixed models; MD, mean deviation; NTG, normal-tension glaucoma; OCT, optical coherence tomography; ONH, optic nerve head; PPA, peripapillary atrophy; TD, total deviation; Trab MMC, trabeculectomy with mitomycin C; VF, visual field.

Acknowledgment

The authors thank Dr. Masanori Hangai and Dr. Hideo Nakanishi for their support as glaucoma surgeons in charge of the patients in the current study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.