Main Article Content
OBJECTIVE: To compare the retinal nerve fiber layer (RNFL) thickness changes in patients of primary open-angle glaucoma after trabeculectomy versus anti-glaucoma medication.
METHODS: This quasi-experimental study was conducted from 10th February, 2017 to 28th February, 2018 on 60 patients presenting to the Institute of Ophthalmology, Mayo Hospital, Lahore, Pakistan using non-probability consecutive sampling. Patients were assigned to two equal groups: group A (n=30) patients underwent trabeculectomy while group B (n=30) patients were put on anti-glaucoma medication. Pre-treatment and three months post-treatment RNFL thickness was recorded and then analyzed using SPPSv.18.0.
RESULTS: Out of 60 patients, Group A (n=30) had 14 (46.71%) males and 16 (53.31%) females, while Group B (n=30) had 16 (53.31%) males and 14 (46.71%) females. The mean age was 55.901±4.221 and 55.431±3.971 years in Group A and Group B respectively (p=0.661). In age group, 16 (53.31%) each in Group A and Group B were <55 years. Hypertensive status showed 9 (30.01%) and 5 (16.71%) hypertensive patients in Group A and Group B respectively. Mean change in RNFL thickness was 0.028±0.012μ and 0.013±0.007μ in Group A and Group B respectively (p=<0.001). Pre and post-treatment (pre:post) RNFL thickness (μ) in males, females, hypertensive, non-hypertensive, age <55 years, and age ≥55 years was 0.201±0.175μ:0.226±0.155, 0.205±0.159:0.233±0.019, 0.193±0.015:0.223±0.013, 0.206±0.015:0.233±0.018, 0.208±0.015:0.232±0.021, and 0.196±0.016:0.228±0.015 for Group A and 0.211±0.018:0.224±0.019, 0.201±0.015:0.215±0.014, 0.214±0.015:0.226±0.016, 0.205±0.018:0.218±0.017, 0.206±0.017:0.219±0.015, and 0.209±0.019:0.221±0.020 for group B respectively.
CONCLUSION: Trabeculectomy increases thickness of retinal nerve fiber layer more than anti glaucoma medication.
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
2. Vranka JA, Kelley MJ, Acott TS, Keller KE. Extra cellular matrix in trabecular meshwork: Intraocular pressure regulation and dysregulation in glaucoma. Exp Eye Res 2015;133:112-25. DOI: 10.1016/j.exer.2014.07.014.
3. Gracitelli CPB, Abe RY, Tatham AJ, Rosen PN, Zangwill LM, Boer ER et al. Association between progressive retinal nerve fiber layer loss and longitudinal changes in quality of life in glaucoma. JAMA Ophthalmol 2015;133(4):384-90. DOI: 10.1001/jamaophthalmol.2014.5319.
4. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology 2014;121(11):2081-90. DOI: 10.1016/j.ophtha.2014.05.013.
5. Kapetanakis VV, Chan MPY, Foster PJ, Cook DJ, Owen CG, Rudnicka AR. Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): A systematic review and metaanalysis. Br J Ophthalmol 2016;100:86-93. DOI: 10.1136/bjophthalmol-2015-307223.
6. Schultz SK, Iverson SM, Shi W, Greenfield DS. Achieving single-digit intraocular pressure targets with filtration surgery in eyes with progressive normal tension glaucoma. J Glaucoma 2016;25(2):217-22. DOI: 10.1097/IJG.0000000000000145.
7. Quaranta L, Riva I, Gerardi C, Oddone F, Floriano I, Konstas AGP. Quality of life in glaucoma: A review of the literature. Adv Therap 2016;33(6):959-81. DOI: 10.1007/s12325-016-0333-6.
8. Behzad A, Lin SC, Ying H, Jane K. A role for antimetabolites in glaucoma tube surgery: Current evidence and future directions. Curr Opin Ophthalmol 2016;27(2):164-9. DOI: 10.1097/ICU.0000000000000244.
9. Harwerth RS, Quigley HA. Visual field defects and retinal ganglion cell losses in patients with glaucoma. Arch Ophthalmol 2006;124(6):853-9. DOI:10.1001/archopth.124.6.853.
10. Yarmohammadi A, Zangwill LM, Diniz-Filho A, Suh MH, Yousefi S, Saunders LJ, et al. Relationship between optical coherence tomography angiography vessel density and severity of visual field loss in glaucoma. Ophthalmology 2016;123(12):2498-508. DOI: 10.1016/j.ophtha.2016.08.041.
11. Mendez-Hernandez C, Rodriguez-Una I, Rosa MG, Arribas-Pardo P, Garcia-Feijoo J. Glaucoma diagnostic capacity of optic nerve head haemoglobin measures compared with spectral domain OCT and HRT III confocal tomography. Act Ophthalmol 2016;94(7):697-704. DOI: 10.1111/aos.13050.
12. Banister K, Boachie C, Bourne R, Cook J, Burr JM, Burr JM, et al. Can automated imaging for optic disc and retinal nerve fiber layer analysis aid glaucoma detection. Ophthalmology 2016;123(5):930-8. DOI: 10.1016/j.ophtha.2016.01.041.
13. Laura SH, Wolfgang S, Robert L, Folkert H, Anslem J, Kruse FE, et al. Confocal laser scanning tomography to predict visual field conversion in patients with ocular hypertension and early glaucoma. J Glaucoma 2016;25(4):371-6. DOI: 10.1097/IJG.0000000000000171.
14. Raghu N, Pandav SS, Kaushik S, Ichhpujani P, Gupta A. Effect of trabeculectomy on RNFL thickness and optic disc parameters using optical coherence tomography. Eye 2012;26(8):1131-7. DOI: 10.1038/eye.2012.115.
15. Maneesang S, Jatutong O, LemsomboomW. The assesment of retinal nerve fiber layer thickness changing after glaucoma surgery by Optical Coherence Tomography, Pharmongkutklao Hospital. J Med Assoc Thai 2012;95(5):75-9.
16. Chang PT, Sekhon N, Budenz DL, Feuer WJ, Park PW, Anderson DR. Effect of lowering intraocular pressure on Optical Coherence Tomography measurement of peripapillary retinal nerve fiber layer thickness. Ophthalmology 2007;114(12):2252-8. DOI: 10.4103/0974-620x.127910
17. Park KH, Kim DM, Youn DH. Short term change of optic nerve head topography after trabeculectomy in adult glaucoma patients as measured by Heidelberg retinal tomograph. Korean J Ophthalmol 1997;11:1-6. DOI: 10.3341/kjo.19220.127.116.11.
18. Yamada N, Tomita G, Yamamoto T, Kitazawa Y. Changes in nerve fiber layer thickness following a reduction of intraocular pressure after trabeculectomy. J Glaucoma 2000;9(5):371-5. DOI: 10.1097/00061198-200010000-00005.
19. Aydin A, Wollstein G, Price LL, Fujimoto JG, Schumann JS. Optical coherence tomography assessment of retinal nerve fiber layer thickness changes after glaucoma surgery. Ophthalmology 2003;110(8):1506-11. DOI: 10.1016/S0161-6420(03)00493-7.
20. Koraszewska-Matuszeuska B, Samochowiec-Donocik E. Evaluation of retinal nerve fiber layer thickness in eyes with juvenile glaucoma after trabeculectomy. Klin Oczna 2004;106(suppl 3):443-4.
21. Rebolleda G, Munoz-Negrete FJ, Noval S. Evaluation of changes in peripapillary nerve fiber layer thickness after deep sclerectomy with optical coherence tomography. Ophthalmology 2007;114(3):488-93. DOI: 10.1016/j.ophtha.2006.06.051.