Nakakura Shunsuke, Asaoka Ryo, Kiuchi Yoshiaki
Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN.
Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Cureus. 2021 Feb 23;13(2):e13520. doi: 10.7759/cureus.13520.
Glaucoma is one of the leading causes of blindness worldwide, and reduction of intraocular pressure (IOP) is the only available evidence-based treatment that reduces visual field deterioration in glaucoma. We present a representative case of structural recovery and recovery of visual field progression after successful trabeculectomy (TLE) with long-term follow-up. A 35-year-old woman with glaucoma visited our hospital in 2008. The IOP in her right eye was 11 mmHg at the first visit, and subsequently increased to values in the high teens to 20 mmHg despite treatment with anti-glaucoma eye drops. During this period, the progression of this eye's visual field deterioration was fast (mean deviation [MD] slope = -0.63 dB/year) and the optic disc cupping was advanced. In the seven-year period after successful TLE in 2014, the IOP declined to between 8 and 12 mmHg without any anti-glaucoma medication. During the first two years after TLE, the MD values were poorer than those before TLE. However, by 2020, MD values improved gradually to a state better than that before the surgery (MD slope during this period was +0.75 dB/year). The appearance of the optic disc was monitored using fundus photography, which showed optic disc morphological changes during topical glaucoma medication before and after TLE. In particular, a remarkable reversal of optic disc cupping enlargement started at two weeks after TLE, and the optic disc shape in 2021 was similar to that in 2008. Minimally invasive glaucoma surgeries are often preferred; however, our findings suggest that successful TLE followed by long-term rigorous IOP control can result in structural recoveries. Additionally, despite the deterioration in visual field in the early years after TLE, in the long term, it may settle down to the same level before the surgery with recovery of visual field progression, which may be a part of functional recovery.
青光眼是全球主要致盲原因之一，降低眼压（IOP）是唯一经循证医学证实可减少青光眼视野恶化的治疗方法。我们展示了一例小梁切除术（TLE）成功后伴有长期随访的结构恢复及视野进展恢复的典型病例。一名患有青光眼的35岁女性于2008年就诊于我院。初诊时其右眼眼压为11 mmHg，尽管使用了抗青光眼滴眼液治疗，眼压随后仍升至十几毫米汞柱高位直至20 mmHg。在此期间，该眼视野恶化进展迅速（平均偏差[MD]斜率=-0.63 dB/年），视盘杯状凹陷进展明显。在2014年TLE成功后的七年里，眼压在未使用任何抗青光眼药物的情况下降至8至12 mmHg之间。在TLE后的头两年，MD值比TLE前更差。然而，到2020年，MD值逐渐改善至优于手术前的状态（此期间MD斜率为+0.75 dB/年）。使用眼底照相术对视盘外观进行监测，其显示了TLE前后局部使用青光眼药物期间视盘形态的变化。特别是，视盘杯状凹陷扩大在TLE后两周开始出现显著逆转，2021年视盘形状与2008年相似。微创青光眼手术通常更受青睐；然而，我们的研究结果表明，成功的TLE并随后进行长期严格的眼压控制可导致结构恢复。此外，尽管TLE后早期视野恶化，但从长期来看，视野进展恢复后可能会稳定至手术前的相同水平，这可能是功能恢复的一部分。
