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Postoperative visual acuity decrease and recovery after tube shunt procedure for glaucoma

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Abstract Number: 5247

AuthorBlock: Yingna Liu1, Lijuan Huang1, Qian Liu1, Qian Zhao2, Robert L. Stamper1, Ying Han1
1Ophthalmology, University of California San Francisco, San Francisco, California, United States; 2Stanford University, California, United States;

DisclosureBlock: Yingna Liu, None; Lijuan Huang, None; Qian Liu, None; Qian Zhao, None; Robert L. Stamper, None; Ying Han, None;

Purpose
To determine the course of postoperative vision decrease and recovery after tube shunt implantation for glaucoma, and to determine the risk factors associated with worse vision after tube shunt procedure.

Methods
A retrospective review of consecutive adult patients who underwent tube shunt implantation between January 2008 and December 2017 was conducted. Visual acuity was converted to LogMAR for data analysis. Postoperative best-corrected visual acuity (BCVA) compared to preoperative BCVA was analyzed for postoperative 1 week (POW1), 1 month (POM1), 3 months (POM3) and 6 months (POM6) using repeated measures ANOVA. The proportions of patients with significant vision loss by 3-5 lines and by more than 5 lines were calculated. Logistic regression was conducted to identify individual risk factors associated with worse postoperative vision.

Results
A total of 479 patients with an average age of 64.6±17.2 years were included in the study; 50.9% were males. The mean preoperative visual acuity was 0.75±0.81(95%CI: 0.67-0.83). At POW1 and POM1, mean visual acuity significantly decreased to 0.96±0.83 (95%CI: 0.88-1.04,P <0.001) and 0.82±0.79 (95%CI: 0.74-0.90, P=0.007), respectively. Patients’ mean visual acuity subsequently recovered back to preoperative level at POM3 (mean BCVA 0.77±0.81, 95%CI: 0.69-0.85, P=0.44), and maintained at preoperative level at POM6 (mean BCVA 0.79±0.81, 95%CI: 0.70-0.87, P=0.20). By POM6, 11 patients (2.7%) had mild to moderate vision loss by 3-5 lines, and 5 (1.2%) patients had severe vision loss by more than 5 lines. Univariate analysis showed that phakic status (OR=1.61, P=0.03), without use of 5-Fluorouracil (5-FU, OR=1.92, P=0.016), and the type of tube shunt (OR=1.80, P=0.041) were associated with worse postoperative vision at 6 months. Multivariate analysis also showed phakic status (OR=1.69, P=0.017) and without use of 5-FU (OR=2.0,P=0.011) were associated with worse vision at POM6.

Conclusions
Immediate postoperative vision loss is common after tube shunt procedure. Postoperative vision recovery back to preoperative level on average took place within 3 months. The risk of significant vision loss by more than 3 lines is relatively uncommon, about 4% in our study population. Risk factors included not using anti-fibrotic agents and phakic status prior to tube shunt surgery.

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