Loss of visual acuity after trabeculectomy

Ophthalmology. 1993 May;100(5):599-612. doi: 10.1016/s0161-6420(93)31597-6.


Background: Glaucoma filtration surgery can result in loss of visual acuity by a variety of mechanisms. The existence of "wipe-out" (loss of the central visual field in the absence of other explanation) as a cause of postoperative loss of visual acuity has been debated. This study defines the incidence and etiology of visual acuity loss within 3 months of trabeculectomy.

Methods: The authors reviewed 508 eyes of 440 patients who underwent trabeculectomy to find cases of postoperative visual acuity loss (2 or more Snellen lines or a category change) and randomly selected a control group of 85 eyes to analyze the risk factors for each cause of visual acuity loss.

Results: Forty-two eyes (8.3%) showed loss of visual acuity after 3 months, caused mainly by lens opacification (n = 16), hypotony maculopathy (n = 6), and "wipe-out" (n = 4). Older patients (P = 0.0108), those in whom the visual field preoperatively showed macular splitting (P = 0.0084) and those who had severe hypotony (intraocular pressure [IOP] < or = 2 mmHg) on the first postoperative day (P = 0.0246) were more likely to experience "wipe-out." Older age (P = 0.0495) and shallow anterior chamber (P = 0.0003) were correlated to the development of lens opacification. Hypotony maculopathy was associated with coronary artery disease (P = 0.0397) and systemic hypertension (P = 0.0118).

Conclusions: Lens opacification was the main cause of early visual acuity loss after trabeculectomy, followed by hypotony maculopathy. "Wipe-out," although rare, does exist, and older patients with advanced visual field defects are at increased risk.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cataract / complications
  • Cataract / etiology
  • Female
  • Glaucoma / surgery
  • Humans
  • Incidence
  • Macula Lutea / pathology
  • Male
  • Middle Aged
  • Ocular Hypotension / complications
  • Ocular Hypotension / etiology
  • Retinal Diseases / complications
  • Retinal Diseases / etiology
  • Retrospective Studies
  • Risk Factors
  • Trabeculectomy / adverse effects*
  • Vision Disorders / etiology*
  • Visual Acuity*