Yonsei University study identifies key to vision preservation in glaucoma surgery

A research team from the Yonsei University College of Medicine has identified that managing intraocular pressure (IOP) during the initial postoperative period is more critical for preserving vision in severe glaucoma patients than the specific type of surgery performed.

Analyzing long-term data from 523 eyes treated with trabeculectomy or Ahmed valve implantation between 2005 and 2023, the study found no significant difference in vision loss rates between the two surgical methods. Instead, the stability of IOP during the first month post-surgery emerged as the primary determinant of visual prognosis.

The study revealed that risk patterns for central vision loss differ based on a patient's baseline vision. Patients with relatively well-preserved vision (greater than 0.1) were more vulnerable to low IOP (less than 8 mmHg), potentially due to mechanical deformation of the macula and optic nerve. Conversely, patients with already diminished vision (0.1 or less) were more susceptible to high IOP (greater than 21 mmHg), likely due to reduced blood flow and ischemic damage.

These findings suggest that instead of applying uniform IOP management standards, clinicians should implement customized strategies tailored to the patient's pre-operative vision status to establish new clinical management guidelines for severe glaucoma.