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Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph.
Ophthalmology. 1999 May; 106(5):1013-8.O

Abstract

OBJECTIVE

To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany).

DESIGN

Nonconsecutive observational case series.

PARTICIPANTS AND INTERVENTION

The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery.

MAIN OUTCOME MEASURES

Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup:disc ratio, and change in visual field parameters.

RESULTS

Seventeen patients had pre- and postoperative images suitable for analysis. Mean IOP at the time of image acquisition before surgery was 30.5+/-12 mm Hg, and after surgery 11.8+/-5.2 mm Hg (mean follow-up, 26+/-7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean cup depth (each, P<0.005). The age of the patient correlated highly with change in maximum cup depth (P<0.005). Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio (P = 0.025).

CONCLUSION

Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP.

Authors+Show Affiliations

William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5598, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10328406

Citation

Lesk, M R., et al. "Reversal of Optic Disc Cupping After Glaucoma Surgery Analyzed With a Scanning Laser Tomograph." Ophthalmology, vol. 106, no. 5, 1999, pp. 1013-8.
Lesk MR, Spaeth GL, Azuara-Blanco A, et al. Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph. Ophthalmology. 1999;106(5):1013-8.
Lesk, M. R., Spaeth, G. L., Azuara-Blanco, A., Araujo, S. V., Katz, L. J., Terebuh, A. K., Wilson, R. P., Moster, M. R., & Schmidt, C. M. (1999). Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph. Ophthalmology, 106(5), 1013-8.
Lesk MR, et al. Reversal of Optic Disc Cupping After Glaucoma Surgery Analyzed With a Scanning Laser Tomograph. Ophthalmology. 1999;106(5):1013-8. PubMed PMID: 10328406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph. AU - Lesk,M R, AU - Spaeth,G L, AU - Azuara-Blanco,A, AU - Araujo,S V, AU - Katz,L J, AU - Terebuh,A K, AU - Wilson,R P, AU - Moster,M R, AU - Schmidt,C M, PY - 1999/5/18/pubmed PY - 1999/5/18/medline PY - 1999/5/18/entrez SP - 1013 EP - 8 JF - Ophthalmology JO - Ophthalmology VL - 106 IS - 5 N2 - OBJECTIVE: To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany). DESIGN: Nonconsecutive observational case series. PARTICIPANTS AND INTERVENTION: The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery. MAIN OUTCOME MEASURES: Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup:disc ratio, and change in visual field parameters. RESULTS: Seventeen patients had pre- and postoperative images suitable for analysis. Mean IOP at the time of image acquisition before surgery was 30.5+/-12 mm Hg, and after surgery 11.8+/-5.2 mm Hg (mean follow-up, 26+/-7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean cup depth (each, P<0.005). The age of the patient correlated highly with change in maximum cup depth (P<0.005). Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio (P = 0.025). CONCLUSION: Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/10328406/Reversal_of_optic_disc_cupping_after_glaucoma_surgery_analyzed_with_a_scanning_laser_tomograph_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(99)00526-6 DB - PRIME DP - Unbound Medicine ER -