Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida.
Devers Eye Institute, Legacy Health, Portland, Oregon.
Am J Ophthalmol. 2015 Feb;159(2):378-85.e1. doi: 10.1016/j.ajo.2014.11.012. Epub 2014 Nov 13.
To examine the hypothesis that surgical intraocular pressure (IOP) reduction leads to enhancement of visual field (VF) sensitivity in glaucomatous eyes.
Prospective case-control study.
Patients with uncontrolled IOP requiring trabeculectomy or aqueous drainage device were enrolled. Controls consisted of medically treated glaucoma patients with stable IOP and no change in medical therapy during follow-up. Two baseline preoperative VFs and 3 follow-up VF examinations at 1, 2, and 3 months postoperatively were used for analysis. The same number of VF examinations measured within an 18-month interval was used for control eyes. VF locations with significant change were defined as exceeding 95% test-retest confidence limits based upon the mean sensitivity using the 2 baseline VF exams. The number of significantly changing locations per eye and changes in mean and pattern standard deviation (PSD) from the mean baseline fields were compared between groups using a Poisson generalized estimating equation model.
Thirty eyes of 30 surgically treated glaucoma patients and 41 eyes of 28 stable controls were enrolled. Postoperative IOP was decreased at follow-up 3 compared with baseline (P < .001) in the surgical eyes, but was similar in control eyes (P = .92). At follow-up 3, the number of test locations improving in central (P = .014) and peripheral (P = .019) VF locations was significantly greater in the surgical eyes. The number of eyes with improved PSD at follow-up 3 was significantly greater in the surgical eyes compared with controls (P = .02).
Short-term enhancement of central and peripheral VF sensitivity occurs after surgical reduction of IOP in glaucomatous eyes and may represent a potential biomarker for retinal ganglion cell response to therapeutic interventions in glaucoma.
检验手术眼内压（IOP）降低导致青光眼视野（VF）敏感性增强的假说。
前瞻性病例对照研究。
招募需要行小梁切除术或房水引流装置的未控制 IOP 的患者。对照组由接受药物治疗的青光眼患者组成，这些患者的 IOP 稳定，在随访期间药物治疗没有变化。使用术前 2 个基础 VF 和术后 1、2 和 3 个月的 3 个随访 VF 检查进行分析。对照组使用在 18 个月间隔内测量的相同数量的 VF 检查。根据使用 2 个基础 VF 检查的平均敏感性，将具有显著变化的 VF 位置定义为超过 95%的测试-重测置信限。使用泊松广义估计方程模型比较两组每只眼的显著变化位置数以及平均基线场的平均和模式标准偏差（PSD）变化。
纳入 30 只手术治疗青光眼患者的 30 只眼和 28 例稳定对照组的 41 只眼。与基线相比，手术眼的术后眼压在随访 3 时降低（P<.001），但对照组的眼压相似（P=.92）。在随访 3 时，中央（P=.014）和周边（P=.019）VF 位置中改善测试位置的数量在手术眼中显著增加。与对照组相比，手术眼中在随访 3 时 PSD 改善的眼数显著增加（P=.02）。
在青光眼患者中，IOP 手术降低后会出现中央和周边 VF 敏感性的短期增强，这可能代表治疗干预后视网膜神经节细胞反应的潜在生物标志物。
