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Samin Hong, MD; Gong Je Seong, MD, PhD; Young Jae Hong, MD, PhD

Arch Ophthalmol. 2007;125(8):1010-1013.

Objective  To evaluate the association of long-term intraocular pressure (IOP) fluctuation and visual field (VF) progression in patients with glaucoma and low IOP.

Methods  Four hundred eight eyes with IOPs below 18 mm Hg after a triple procedure (phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy) were included in this study. Measurements of IOP and VF were taken for at least 3 years after surgery. Based on the SD in postoperative IOPs, the sample was split into 2 groups (group 1: SD 2; group 2: SD >2). Change in VF at each test location was defined as a change in threshold sensitivity of 1 dB per year or higher, with P.01; pointwise linear regression analysis was applied.

Main Outcome Measures  Intraocular pressure and VF progression.

Results  The groups showed no differences in IOPs through the follow-up period and in the VF defect score 3 months after surgery. After 13 years, more patients with progressive VF deterioration were detected in group 2 than in group 1.

Conclusion  Our results showed that larger long-term IOP fluctuation was associated with a progressive increase in the VF deterioration even though patients with glaucoma maintained their IOPs after the triple procedure.

Application to Clinical Practice  The SD of long-term IOP should be less than 2 in patients with glaucoma, even if their IOPs drop below 18 mm Hg.

Trial Registration  clinicaltrials.gov Identifier: NCT00428740

Author Affiliations: Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

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