eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Complications and Management of Glaucoma Filtering: Follow-up

Author: Antonio Pascotto, MD, Consulting Ophthalmologist, Pascotto, Istituto per la Salute degli Occhi, Clinica Mediterranea, Italy
Coauthor(s): Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy; Mauro Fioretto, MD, Professor of Ophthalmology, University Eye Clinic of Genova; Head of Ophthalmology Department, Hospital of Casale Monferrato, Italy; Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Contributor Information and Disclosures

Updated: Nov 1, 2006

Outcome and Prognosis

The goal of glaucoma-filtering surgery is to arrest the progression of the disease via a reduction in IOP. Glaucoma-filtering surgery is successful in maintaining normal IOP in approximately 80-85% of patients; the remaining patients require either medical therapy or reoperation for adequate control.

The Advanced Glaucoma Intervention Study (AGIS) was conducted to examine the relationship between IOP and progression of visual field damage over 6 or more years of follow-up. According to the investigators, "eyes with 100% of visits with IOP less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up." Results of this study support evidence from earlier studies showing the protective role of low IOP in visual field deterioration.5

The outcome of surgery is improved if the operation is undertaken before the increased IOP causes serious damage to the optic nerve fibers. The prognosis is poor if the surgery is performed in the late stages of this disease.

Future and Controversies

The current practice of filtration surgery, especially with the use of antifibrotic agents (eg, MMC), creates eyes that can develop conjunctival leaks, infections, and problems due to filtration blebs. Nonpenetrating surgery may avoid these problems, but it is subject to long-term failures as the eye continues healing and wound remodeling occurs. Improvements in the surgical control of IOP are expected in the future.

 


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Follow-up: Glaucoma, Complications and Management of Glaucoma Filtering
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References
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References

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Further Reading

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Keywords

ocular hypertension, increased intraocular pressure, IOP, chronic simple glaucoma, POAG, COAG, chronic open-angle glaucoma, primary open-angle glaucoma, glaucomatous atrophy of the optic disc, cupping of the optic disc, low-tension glaucoma, normal tension glaucoma, normal-tension glaucoma, pigmentary glaucoma, pigment dispersion syndrome, acute glaucoma, narrow angle glaucoma, narrow-angle glaucoma, primary angle-closure glaucoma, borderline glaucoma, anatomical narrow angle, anatomic narrow angle, secondary glaucoma, congenital glaucoma, high pressure inside the eye, increased IOP, elevated IOP, high IOP, increased intraocular pressure, elevated intraocular pressure, high intraocular pressure, high eye pressure, elevated eye pressure, increased eye pressure, optic nerve damage, visual field defect, vision loss, blindness, surgical drainage, aqueous humor

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Contributor Information and Disclosures

Author

Antonio Pascotto, MD, Consulting Ophthalmologist, Pascotto, Istituto per la Salute degli Occhi, Clinica Mediterranea, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy
Disclosure: Nothing to disclose.

Mauro Fioretto, MD, Professor of Ophthalmology, University Eye Clinic of Genova; Head of Ophthalmology Department, Hospital of Casale Monferrato, Italy
Disclosure: Nothing to disclose.

Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Vincenzo Orfeo, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Neil T Choplin, MD, Adjunct Clinical Professor, Department of Surgery, Section of Ophthalmology, Uniformed Services University of Health Sciences
Neil T Choplin, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Association for Research in Vision and Ophthalmology, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin B Wax, MD, Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience
Disclosure: Alcon Labs Salary Employment

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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